Provider Demographics
NPI:1306817960
Name:AMERIPATH 501A CORPORATION
Entity Type:Organization
Organization Name:AMERIPATH 501A CORPORATION
Other - Org Name:COCKERELL AND ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-550-3000
Mailing Address - Street 1:7111 FAIRWAY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4207
Mailing Address - Country:US
Mailing Address - Phone:561-712-6200
Mailing Address - Fax:561-712-7349
Practice Address - Street 1:2330 BUTLER ST
Practice Address - Street 2:SUITE 115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7828
Practice Address - Country:US
Practice Address - Phone:800-309-0000
Practice Address - Fax:214-630-5210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-31
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0677505291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7001145Medicaid
KY3790343200Medicaid
TN4490764Medicaid
MT420891Medicaid
TX025447601Medicaid
AR132904709Medicaid
GA000814734AMedicaid
WI32919900Medicaid
NM000J6113Medicaid
KS100447800AMedicaid
SCL00018Medicaid
MS0122415Medicaid
SCL00018Medicaid
AR132904709Medicaid
UT=========002Medicaid