Healthcare Provider Details

I. General information

NPI: 1184621864
Provider Name (Legal Business Name): LARGO AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 13TH ST SW
LARGO FL
33770-3127
US

IV. Provider business mailing address

PO BOX 2410
LARGO FL
33779-2410
US

V. Phone/Fax

Practice location:
  • Phone: 727-450-3030
  • Fax: 727-450-3031
Mailing address:
  • Phone: 727-450-3030
  • Fax: 727-450-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1162
License Number StateFL

VIII. Authorized Official

Name: STEPHEN MARK WEINSTOCK
Title or Position: OWNER/PRESIDENT/MEDICAL DIRECTOR
Credential: MD
Phone: 727-581-8706