Healthcare Provider Details

I. General information

NPI: 1770081507
Provider Name (Legal Business Name): ECCOLAB GROUP CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W WATERS AVE STE 1B
TAMPA FL
33614-1866
US

IV. Provider business mailing address

8370 W FLAGLER ST STE 216
MIAMI FL
33144-2038
US

V. Phone/Fax

Practice location:
  • Phone: 813-932-9525
  • Fax:
Mailing address:
  • Phone: 800-616-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800023191
License Number StateFL

VIII. Authorized Official

Name: JORGE MESA
Title or Position: PRESIDENT
Credential:
Phone: 305-220-3805