Provider Demographics
NPI:1114055142
Name:ADVANCED HAND AND PLASTIC SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ADVANCED HAND AND PLASTIC SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARGASZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-866-4426
Mailing Address - Street 1:PO BOX 198551
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8551
Mailing Address - Country:US
Mailing Address - Phone:813-866-4426
Mailing Address - Fax:813-972-8866
Practice Address - Street 1:2318 GREENBRANCH DR
Practice Address - Street 2:SUITE 101-102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6797
Practice Address - Country:US
Practice Address - Phone:813-866-4426
Practice Address - Fax:813-972-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272754400Medicaid
FL16038ZMedicare ID - Type Unspecified
FL272754400Medicaid