Provider Demographics
NPI:1578535456
Name:AMERIPATH CLEVELAND INC
Entity type:Organization
Organization Name:AMERIPATH CLEVELAND INC
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
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:800-331-7546
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:2451 EDISON BLVD STE A
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2340
Practice Address - Country:US
Practice Address - Phone:440-703-2100
Practice Address - Fax:440-703-2155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-03
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0656067291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000024771OtherBCBS
MI164729542Medicaid
TX1718561Medicaid
OH690031091OtherMC RR
NC7001332Medicaid
PA101272607Medicaid
VA1578535456Medicaid
MD4104722Medicaid
AZ084918Medicaid
SCL00234Medicaid
OH0318525Medicaid
AK158988709Medicaid
WI36201300Medicaid
CO90386574Medicaid
VA1578535456Medicaid