Basic Information
| Provider Information | |||||||||
| NPI: | 1124075635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED PATHOLOGISTS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ANATOMIC PATHOLOGY LAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 VIRGINIA WAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152214474 | ||||||||
| FaxNumber: | 6152343774 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 AIRPARK CENTER DR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372175200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152214474 | ||||||||
| FaxNumber: | 6152343774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | BEN | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6152214474 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 3319 | TN | N | Laboratories | Clinical Medical Laboratory | 291U00000X | 4009 | TN | N | Laboratories | Clinical Medical Laboratory | 291U00000X | 4121 | TN | N | Laboratories | Clinical Medical Laboratory | 291U00000X | 3322 | TN | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 00125823 | 05 | MS | MEDICAID | 1157106 | 01 | KY | PASSPORT | OTHER | 37000262 | 05 | KY | MEDICAID | 009967330 | 05 | AL | MEDICAID | 000924811A | 05 | GA | MEDICAID | 200370130A | 05 | IN | MEDICAID | 3403923 | 05 | TN | MEDICAID | 690009219 | 01 | RAILROAD MEDICARE | OTHER | 28707 | 01 | TN | TLC TENNCARE | OTHER | 4057394 | 01 | TN | BLUE SHIELD | OTHER |