MEDICARE: LASERSCOPIC MEDICAL CENTER

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	207X00000X	Orthopaedic Surgery Physician	684	FL

General Provider Information

NPI Number	:	1871593657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LASERSCOPIC MEDICAL CENTER

Provider Business Mailing Address
First Line	:	5000 PARK ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2254
Country	:	US
Telephone Number	:	727-546-6566
Fax Number	:	727-546-6560

Provider Business Practice Location Address
First Line	:	5000 PARK ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2254
Country	:	US
Telephone Number	:	727-546-6566
Fax Number	:	727-546-6560

Authorized Official
Title or Position	:	CEO
Name	:	JOE SAMUEL BAILEY
Credential	:
Telephone Number	:	727-546-6566

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/22/2020

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Directions to “LASERSCOPIC MEDICAL CENTER ” Practice Location

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