=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568674281
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGES ENDOSCOPY & SURGICAL CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 12/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10900 SE 174TH PLACE
-----------------------------------------------------
City | SUMMERFIELD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-245-7427
-----------------------------------------------------
Fax | 352-245-2387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10900 SE 174TH PLACE
-----------------------------------------------------
City | SUMMERFIELD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-245-7427
-----------------------------------------------------
Fax | 352-245-2387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LALBAHADUR S NAGABHAIRU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 352-245-7427
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------