1184621864 NPI number — LARGO AMBULATORY SURGERY CENTER LLC

Table of content: RACHEL ANNE HAMMANN LSW (NPI 1295204592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184621864 NPI number — LARGO AMBULATORY SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LARGO AMBULATORY SURGERY CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184621864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33779-2410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-450-3030
Provider Business Mailing Address Fax Number:
727-450-3031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 13TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33770-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-450-3030
Provider Business Practice Location Address Fax Number:
727-450-3031
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WEINSTOCK
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
OWNER/PRESIDENT/MEDICAL DIRECTOR
Authorized Official Telephone Number:
727-581-8706

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  1162 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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