Healthcare Provider Details

I. General information

NPI: 1831195379
Provider Name (Legal Business Name): LARGO SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W BAY DR
LARGO FL
33770-2207
US

IV. Provider business mailing address

1401 W BAY DR
LARGO FL
33770-2207
US

V. Phone/Fax

Practice location:
  • Phone: 727-585-9500
  • Fax: 727-584-1938
Mailing address:
  • Phone: 727-585-9500
  • Fax: 727-584-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number781
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800005342
License Number StateFL

VIII. Authorized Official

Name: JENNIFER BOYD BALDOCK
Title or Position: OFFICER AND AUTHORIZED
Credential:
Phone: 615-234-5954