Provider Demographics
NPI:1952381477
Name:AMERIPATH FLORIDA LLC
Entity type:Organization
Organization Name:AMERIPATH FLORIDA LLC
Other - Org Name:<UNAVAIL>
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
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 1:895 SW 30TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4887
Practice Address - Country:US
Practice Address - Phone:954-633-3387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-19
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D0645438291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200824370AMedicaid
AL690000002Medicaid
FL004307900Medicaid
ME431998200Medicaid
MI4854522Medicaid
GA00746567AMedicaid
NJ0093220Medicaid
NC7001143Medicaid
OH2083785Medicaid
KY7100053620Medicaid
MT0420070Medicaid
CO55030777Medicaid
SCL00080Medicaid
VA001033336Medicaid
MO706225901Medicaid
TX176179301Medicaid
OK200008140BMedicaid
MD409313500Medicaid
FL0303224-00Medicaid
NM35929022Medicaid
PA1007498800006Medicaid
LA1359033Medicaid
UT1952381477Medicaid
MN1952381477Medicaid
NE1952381477Medicaid
FL0303224-00Medicaid
UT1952381477Medicaid