Provider Demographics
NPI:1376651554
Name:ERIC S PALOSKY, DO PA
Entity Type:Organization
Organization Name:ERIC S PALOSKY, DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PALOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:863-385-1777
Mailing Address - Street 1:4343 SUN N LAKE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2162
Mailing Address - Country:US
Mailing Address - Phone:863-385-1777
Mailing Address - Fax:863-385-8668
Practice Address - Street 1:4343 SUN N LAKE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2162
Practice Address - Country:US
Practice Address - Phone:863-385-1777
Practice Address - Fax:863-385-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D1021161OtherCLIA - LAB
FL46263OtherBCBS OF FLORIDA
FLS0007466OtherFL MEDICAL LICENSE - W/C
FL026582690OtherTRICARE INDIVIDUAL
FLS0007466OtherFL MEDICAL LICENSE - W/C
FL46263OtherBCBS OF FLORIDA
FL46263OtherBCBS OF FLORIDA
FLP00071836Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FL026582690OtherTRICARE INDIVIDUAL
FL10D1021161OtherCLIA - LAB