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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