Provider Demographics
NPI:1821238023
Name:AMERIPATH CONSULTING PATHOLOGY SERVICES PA
Entity Type:Organization
Organization Name:AMERIPATH CONSULTING PATHOLOGY SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
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:
Authorized Official - Phone:610-550-3000
Mailing Address - Street 1:7111 FAIRWAY DRIVE
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 1:1710 HARPER RD
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3357
Practice Address - Country:US
Practice Address - Phone:304-256-4161
Practice Address - Fax:304-254-3011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-27
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016309Medicaid
WV51D0705082OtherCLIA
WV3810016309Medicaid