MEDICARE: ARMENIA AMBULATORY SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	1094	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68H	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750331500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARMENIA AMBULATORY SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	2333 W HILLSBOROUGH AVE STE 120
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1052
Country	:	US
Telephone Number	:	813-871-9032
Fax Number	:	813-870-9543

Provider Business Practice Location Address
First Line	:	2333 W HILLSBOROUGH AVE STE 120
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1052
Country	:	US
Telephone Number	:	813-871-9032
Fax Number	:	813-870-9543

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JENNIFER BOYD BALDOCK
Credential	:
Telephone Number	:	615-234-5900

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	12/17/2018

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