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General NPI Number Information
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NPI Number | 1659674232
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Entity Type | Organization
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Legal Business Name | FROSTPROOF MEDICAL AND SURGICAL CENTER PA
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Dates
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Enumeration Date | 12/21/2010
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 45 DEVANE ST
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City | FROSTPROOF
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State | FL
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Zip | 33843-2017
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Country | US
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Telephone | 813-685-2191
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Fax | 813-689-8755
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Provider Business Mailing Address
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Address Line | 45 DEVANE ST
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City | FROSTPROOF
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State | FL
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Zip | 33843-2017
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Country | US
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Telephone | 813-685-2191
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Fax | 813-689-8755
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Authorized Official
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Title or Position | BILLING REPRESENTATIVE
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Name | MRS. PEGGY VENT
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Credential |
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Telephone | 813-685-2191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME0033487
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License Number State | FL
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