Provider Demographics
NPI:1730151317
Name:AMERIPATH TEXAS, INC.
Entity type:Organization
Organization Name:AMERIPATH TEXAS, INC.
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:
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:972-934-4300
Mailing Address - Fax:972-455-1212
Practice Address - Street 1:2501 S STATE HIGHWAY 121 BUS STE 1210
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4394
Practice Address - Country:US
Practice Address - Phone:972-891-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-07
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D1066386291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025473201Medicaid
OK100759140AMedicaid
OK100759140FMedicaid
TXCL8032OtherBCBS
MS09084043Medicaid
AKLB602TXMedicaid
AR190071709Medicaid
NM78770262Medicaid
LA1347183Medicaid
AR189970709Medicaid
MS09084043Medicaid
OK100759140AMedicaid