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Organization
PLASTIC SURGERY CENTER OF LAKE COUNTY
Active
Organization
PLASTIC SURGERY CENTER OF LAKE COUNTY
Active
Other names
Bosshardt & Marzek Plastic Surgery Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VERA D. RENFRO (OFFICE ADMINISTRATOR)
(352) 742-0079
Entity
Organization
Contact information
Practice address
1879 NIGHTINGALE LN, A-2, TAVARES, FL 32778-4363
(352) 742-0079
(352) 742-0059
Mailing address
1879 NIGHTINGALE LN, A-2, TAVARES, FL 32778-4363
(352) 742-0079
(352) 742-0059
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1049
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252761801
—
FL
01
—
490003374
RAILROAD MEDICARE
FL
01
—
6B8
BLUE CROSS AND SHIELD FL
FL
Enumeration date
07/03/2006
Last updated
06/18/2008
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