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General NPI Number Information
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NPI Number | 1750456539
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Entity Type | Organization
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Legal Business Name | WIREGRASS RANCH ASC HOLDINGS LLC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 14547 BRUCE B DOWNS BLVD
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City | TAMPA
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State | FL
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Zip | 33613-2709
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Country | US
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Telephone | 813-978-1494
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Fax | 813-615-0296
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Provider Business Mailing Address
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Address Line | 14547 BRUCE B DOWNS BLVD
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City | TAMPA
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State | FL
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Zip | 33613-2709
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Country | US
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Telephone | 813-979-0440
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Fax | 813-615-0296
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Authorized Official
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Title or Position | VP OF AMBULATORY SURGERY CENTERS
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Name | GAURAV SOOD
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Credential |
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Telephone | 321-841-8346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 1189
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License Number State | FL
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