Provider Demographics
NPI:1265058622
Name:LARGO CLINIC LLC
Entity type:Organization
Organization Name:LARGO CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAMAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-517-1500
Mailing Address - Street 1:10500 ULMERTON RD STE 360
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3504
Mailing Address - Country:US
Mailing Address - Phone:727-517-1500
Mailing Address - Fax:727-595-5392
Practice Address - Street 1:10500 ULMERTON RD STE 360
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3504
Practice Address - Country:US
Practice Address - Phone:727-517-1500
Practice Address - Fax:727-595-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty