Provider Demographics
NPI:1427019108
Name:TAMARAC PATHOLOGY GROUP PA
Entity Type:Organization
Organization Name:TAMARAC PATHOLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESCLOPIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FCAP
Authorized Official - Phone:352-795-8372
Mailing Address - Street 1:PO BOX 2030
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34447-2030
Mailing Address - Country:US
Mailing Address - Phone:352-621-3100
Mailing Address - Fax:352-621-3121
Practice Address - Street 1:6201 N SUNCOAST BLVD
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-6712
Practice Address - Country:US
Practice Address - Phone:352-795-8372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272974100Medicaid
FL94803OtherBLUE CROSS BLUE SHIELD
DE4684OtherRAILROAD MEDICARE
FL94803OtherBLUE CROSS BLUE SHIELD