Provider Demographics
NPI:1811423726
Name:CICLOPS TELEPATHOLOGY LLC
Entity Type:Organization
Organization Name:CICLOPS TELEPATHOLOGY LLC
Other - Org Name:THE SKIN CANCER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:CONDON
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-612-8388
Mailing Address - Street 1:2300 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3933
Mailing Address - Country:US
Mailing Address - Phone:601-490-7272
Mailing Address - Fax:607-490-7276
Practice Address - Street 1:2300 12TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3933
Practice Address - Country:US
Practice Address - Phone:601-490-7272
Practice Address - Fax:601-490-7276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20291207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty