Provider Demographics
NPI:1619940517
Name:AMERIPATH FLORIDA LLC
Entity Type:Organization
Organization Name:AMERIPATH FLORIDA LLC
Other - Org Name:AMERIPATH CENTRAL FLORIDA (ACF)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-697-8378
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:4225 E FOWLER AVE STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-2026
Practice Address - Country:US
Practice Address - Phone:813-972-7100
Practice Address - Fax:813-972-8269
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-10
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D0275299291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200008140AMedicaid
OH2375960Medicaid
KY37000106Medicaid
CO88530850Medicaid
AR149554709Medicaid
FL030579102Medicaid
MI4393873Medicaid
AZ830093Medicaid
NC7001213Medicaid
SCL00206Medicaid
OK200008140AMedicaid
KY37000106Medicaid
FL004634600Medicaid
WI32939400Medicaid
CO88530850Medicaid
GA00792624AMedicaid
FL030579102Medicaid
TX1549099-01Medicaid
IA0549220Medicaid
AR149554709Medicaid
IN200359240AMedicaid
OH2375960Medicaid
NC7001213Medicaid
AR149554709Medicaid