Provider Demographics
NPI:1730500935
Name:BARDMOOR SURGERY CENTER LLC
Entity type:Organization
Organization Name:BARDMOOR SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-394-6747
Mailing Address - Street 1:8787 BRYAN DAIRY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1252
Mailing Address - Country:US
Mailing Address - Phone:727-394-5900
Mailing Address - Fax:727-394-5333
Practice Address - Street 1:8787 BRYAN DAIRY RD STE 300
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1252
Practice Address - Country:US
Practice Address - Phone:727-394-5900
Practice Address - Fax:727-394-5333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYCARE HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-16
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical