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Organization
LASER AND OUTPATIENT SURGERY CENTER LLC
Active
Organization
LASER AND OUTPATIENT SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
(615) 234-5954
Entity
Organization
Contact information
Practice address
6925 NW 11TH PL, GAINESVILLE, FL 32605-3101
(352) 331-1590
(352) 331-0995
Mailing address
6925 NW 11TH PL, GAINESVILLE, FL 32605-3101
(352) 331-1590
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1253
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076650000
—
FL
01
—
P00346824
RR MEDICARE
—
Enumeration date
07/17/2006
Last updated
02/21/2023
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