Provider Demographics
NPI:1093057986
Name:3XS PLLC
Entity Type:Organization
Organization Name:3XS PLLC
Other - Org Name:ST MINA PRIMARY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWANDY
Authorized Official - Middle Name:FAWZY
Authorized Official - Last Name:BOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-796-5102
Mailing Address - Street 1:14391 SPRING HILL DR
Mailing Address - Street 2:SUITE 444
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8199
Mailing Address - Country:US
Mailing Address - Phone:352-796-5102
Mailing Address - Fax:352-796-2144
Practice Address - Street 1:17222 HOSPITAL BLVD
Practice Address - Street 2:SUITE 242
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8925
Practice Address - Country:US
Practice Address - Phone:352-796-5102
Practice Address - Fax:352-796-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty