Provider Demographics
NPI:1831228709
Name:ECCOLAB GROUP CO
Entity type:Organization
Organization Name:ECCOLAB GROUP CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDET
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-220-3805
Mailing Address - Street 1:8370 W FLAGLER ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2094
Mailing Address - Country:US
Mailing Address - Phone:305-220-3805
Mailing Address - Fax:305-220-3813
Practice Address - Street 1:8370 W FLAGLER ST
Practice Address - Street 2:SUITE 216
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2094
Practice Address - Country:US
Practice Address - Phone:305-220-3805
Practice Address - Fax:305-220-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800016716291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030696700Medicaid