Basic Information
| Provider Information | |||||||||
| NPI: | 1881666741 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMERIPATH CINCINNATI INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | RICHFIELD LAB OF DERMATOPATHOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2560 N SHADELAND AVE STE A | ||||||||
| Address2: | ATTN: ANN PATTERSON | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462191706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172758072 | ||||||||
| FaxNumber: | 3172758124 | ||||||||
| Practice Location | |||||||||
| Address1: | 9844 REDHILL DR | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452425627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137458330 | ||||||||
| FaxNumber: | 5137450892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 04/04/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DOLAN | ||||||||
| AuthorizedOfficialFirstName: | KRISTIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8666978378 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMERIPATH INC | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 36D0346613 | OH | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 291U00000X | 36D0346613 | OH | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 0505331 | 05 | OH | MEDICAID | 100003810A | 05 | IN | MEDICAID | 1881666741 | 05 | WI | MEDICAID | 342100 | 05 | AZ | MEDICAID | 9141375 00 | 05 | FL | MEDICAID | 000000003310 | 01 | OH | BCBS | OTHER | 7001336 | 05 | NC | MEDICAID | 164246223 | 05 | MI | MEDICAID | 000777917A | 05 | GA | MEDICAID | 10025701400 | 05 | NE | MEDICAID | 102209715 0001 | 05 | PA | MEDICAID | XPY186016 | 05 | CA | MEDICAID | 1881666741 | 05 | MN | MEDICAID | 100357710A | 05 | KS | MEDICAID | 200912300 A | 05 | IN | MEDICAID | 221530310 | 01 | OH | MC RR | OTHER | 3810012030 | 05 | WV | MEDICAID | 68306 | 05 | NM | MEDICAID | 7100043710 | 05 | KY | MEDICAID | 506428 | 05 | IA | MEDICAID | 703803304 | 05 | MO | MEDICAID | 100357710B | 05 | KS | MEDICAID | 86086049 | 05 | CO | MEDICAID |