Provider Demographics
NPI:1164619797
Name:LARGO LUNG ASSOCIATES INC
Entity Type:Organization
Organization Name:LARGO LUNG ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOLUPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-559-8300
Mailing Address - Street 1:1258 W BAY DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2242
Mailing Address - Country:US
Mailing Address - Phone:727-559-8300
Mailing Address - Fax:727-559-7700
Practice Address - Street 1:1258 W BAY DR
Practice Address - Street 2:SUITE E
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2242
Practice Address - Country:US
Practice Address - Phone:727-559-8300
Practice Address - Fax:727-559-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79890207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6036Medicare PIN