Healthcare Provider Details

I. General information

NPI: 1306995063
Provider Name (Legal Business Name): MEDICAL DEVELOPMENT CORPORATION OF PASCO COUNTY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7315 HUDSON AVE
HUDSON FL
34667-1158
US

IV. Provider business mailing address

PO BOX 5485
HUDSON FL
34674-5485
US

V. Phone/Fax

Practice location:
  • Phone: 727-868-9563
  • Fax: 727-869-6909
Mailing address:
  • Phone: 727-868-9563
  • Fax: 727-869-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number894
License Number StateFL

VIII. Authorized Official

Name: MRS. CECILIA O'RYAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-868-9563