Provider Demographics
NPI:1457965832
Name:LASER AND OUTPATIENT SURGERY CENTER LLC
Entity Type:Organization
Organization Name:LASER AND OUTPATIENT SURGERY CENTER LLC
Other - Org Name:GAINESVILLE ANESTHESIA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5900
Mailing Address - Street 1:4919 MEMORIAL HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7500
Mailing Address - Country:US
Mailing Address - Phone:813-291-7015
Mailing Address - Fax:813-527-9537
Practice Address - Street 1:6925 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3101
Practice Address - Country:US
Practice Address - Phone:352-331-1590
Practice Address - Fax:352-331-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty