Provider Demographics
NPI:1265504559
Name:OSCEOLA PATHOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:OSCEOLA PATHOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:ACCOLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:407-518-3703
Mailing Address - Street 1:6149 CARTMEL LN
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5420
Mailing Address - Country:US
Mailing Address - Phone:407-518-3703
Mailing Address - Fax:407-933-5860
Practice Address - Street 1:700 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4924
Practice Address - Country:US
Practice Address - Phone:407-518-3703
Practice Address - Fax:407-933-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3082Medicare ID - Type Unspecified