=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356336069
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASCO REGIONAL MEDICAL CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2005
-----------------------------------------------------
Last Update Date | 02/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13100 FORT KING RD
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33525-5294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-521-1000
-----------------------------------------------------
Fax | 352-521-4028
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13100 FORT KING RD
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33525-5294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-521-1000
-----------------------------------------------------
Fax | 352-521-4028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/DELEGATED OFFICIAL
-----------------------------------------------------
Name | PAULA LALOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-925-4565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------