Organization
AMERIPATH LUBBOCK 5.01(A) CORPORATION
Active
Parent organization
AMERIPATH INC.
Other names
Pathology Associates of Texas
Organization subpart
Yes
Provider details
NPI number
Legal business name
AMERIPATH INC.
Authorized official
DARREN THOMAS WHEELER (VICE PRESIDENT)
(702) 733-7866
Entity
Organization
Contact information
Practice address
1401 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2113
(713) 432-1100
(713) 432-0221
Mailing address
14275 MIDWAY RD, SUITE 400, ADDISON, TX 75001-3614
(610) 271-4245
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
45D0701182
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0T841
BCBS
TX
05
—
121877803
—
TX
05
—
200393940A
—
OK
01
—
45D0914073
CLIA
TX
Enumeration date
12/06/2005
Last updated
09/05/2024
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