Provider Demographics
NPI:1023102043
Name:AMERIPATH LUBBOCK 5.01(A) CORPORATION
Entity type:Organization
Organization Name:AMERIPATH LUBBOCK 5.01(A) CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. TREASURY
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-712-6242
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:214-932-8234
Mailing Address - Fax:214-932-8284
Practice Address - Street 1:4920 S LOOP 289
Practice Address - Street 2:SUITE 101
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-4797
Practice Address - Country:US
Practice Address - Phone:806-744-1887
Practice Address - Fax:806-744-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty