Healthcare Provider Details

I. General information

NPI: 1659674232
Provider Name (Legal Business Name): FROSTPROOF MEDICAL AND SURGICAL CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DEVANE ST
FROSTPROOF FL
33843-2017
US

IV. Provider business mailing address

45 DEVANE ST
FROSTPROOF FL
33843-2017
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-2191
  • Fax: 813-689-8755
Mailing address:
  • Phone: 813-685-2191
  • Fax: 813-689-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME0033487
License Number StateFL

VIII. Authorized Official

Name: MRS. PEGGY VENT
Title or Position: BILLING REPRESENTATIVE
Credential:
Phone: 813-685-2191