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General NPI Number Information
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NPI Number | 1831195379
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Entity Type | Organization
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Legal Business Name | LARGO SURGERY LLC
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 1401 W BAY DR
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City | LARGO
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State | FL
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Zip | 33770-2207
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Country | US
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Telephone | 727-585-9500
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Fax | 727-584-1938
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Provider Business Mailing Address
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Address Line | 1401 W BAY DR
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City | LARGO
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State | FL
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Zip | 33770-2207
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Country | US
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Telephone | 727-585-9500
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Fax | 727-584-1938
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Authorized Official
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Title or Position | OFFICER AND AUTHORIZED
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Name | JENNIFER BOYD BALDOCK
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Credential |
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Telephone | 615-234-5954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 800005342
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 781
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License Number State | FL
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