Healthcare Provider Details

I. General information

NPI: 1801931399
Provider Name (Legal Business Name): MED-SURG PAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 STATE ROAD 674
WIMAUMA FL
33598-3515
US

IV. Provider business mailing address

5121 STATE ROAD 674
WIMAUMA FL
33598-3515
US

V. Phone/Fax

Practice location:
  • Phone: 813-633-8489
  • Fax: 813-633-2669
Mailing address:
  • Phone: 813-633-8489
  • Fax: 813-633-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9100944
License Number StateFL

VIII. Authorized Official

Name: MR. SCOTT ALLEN FRENCH
Title or Position: PRESIDENT OWNER
Credential: PAC
Phone: 813-633-8489