Provider Demographics
NPI:1457508400
Name:AMERIPATH TUCSON, INC
Entity Type:Organization
Organization Name:AMERIPATH TUCSON, INC
Other - Org Name:JILL A COHEN MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-550-3003
Mailing Address - Street 1:14275 MIDWAY DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3676
Mailing Address - Country:US
Mailing Address - Phone:520-320-7681
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:7485 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3477
Practice Address - Country:US
Practice Address - Phone:520-320-7681
Practice Address - Fax:520-320-7684
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-21
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D0980494207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03D0980494OtherCLIA
AZZ70162Medicare PIN