Provider Demographics
NPI:1144579103
Name:EMERALD DIAGNOSTIC SERVICES CORP
Entity Type:Organization
Organization Name:EMERALD DIAGNOSTIC SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-536-4439
Mailing Address - Street 1:7911 NW 72ND AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2227
Mailing Address - Country:US
Mailing Address - Phone:786-536-4439
Mailing Address - Fax:786-536-6572
Practice Address - Street 1:7911 NW 72ND AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-2227
Practice Address - Country:US
Practice Address - Phone:786-536-4439
Practice Address - Fax:786-536-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory