Provider Demographics
NPI:1942374517
Name:AMERIPATH INDIANAPOLIS PC
Entity Type:Organization
Organization Name:AMERIPATH INDIANAPOLIS PC
Other - Org Name:
Other - Org Type:
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:668-697-8378
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:214-932-8018
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:2560 N SHADELAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1706
Practice Address - Country:US
Practice Address - Phone:317-275-8000
Practice Address - Fax:317-275-8124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15D1052105207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000104995OtherANTHEM
IN200168060AMedicaid
INCI4095OtherRAILROAD MEDICARE
KY7100137960Medicaid
IN000000104995OtherANTHEM
IN=========020OtherCHAMPUS
IN200168060AMedicaid