Provider Demographics
NPI:1205607470
Name:AMERIPATH FLORIDA LLC
Entity type:Organization
Organization Name:AMERIPATH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-733-7866
Mailing Address - Street 1:14275 MIDWAY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3661
Mailing Address - Country:US
Mailing Address - Phone:866-697-8378
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:1701 SE HILLMOOR DR STE C11
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7541
Practice Address - Country:US
Practice Address - Phone:813-979-8711
Practice Address - Fax:813-972-8267
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-15
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory