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NPI Code Detail

MEDICARE: LARGO SURGERY LLC

MEDICARE: LARGO SURGERY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory800005342FL
2261QA1903XAmbulatory Surgical Clinic/Center781FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20771519008OTHERCIGNA
3691OTHERFLBLUE CROSS/BLUE SHIELD
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831195379
Entity Type Code : Organization
Provider Name (Legal Business Name) : LARGO SURGERY LLC
Provider Business Mailing Address
First Line : 1401 W BAY DR
Second Line :
City : LARGO
State : FL
Zip : 33770-2207
Country : US
Telephone Number : 727-585-9500
Fax Number : 727-584-1938
Provider Business Practice Location Address
First Line : 1401 W BAY DR
Second Line :
City : LARGO
State : FL
Zip : 33770-2207
Country : US
Telephone Number : 727-585-9500
Fax Number : 727-584-1938
Authorized Official
Title or Position : OFFICER AND AUTHORIZED
Name : JENNIFER BOYD BALDOCK
Credential :
Telephone Number : 615-234-5954
Provider Enumeration Date : 06/21/2005
Last Update Date : 06/26/2023

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Directions to “LARGO SURGERY LLC ” Practice Location

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