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LARGO PHYSICIAN GROUP LLC NPI 1578732889


NPI Information

NPI: 1578732889
Provider Name: LARGO PHYSICIAN GROUP, LLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 10D2113641

Address:
11373 CORTEZ BLVD STE 408
BROOKSVILLE, FL
ZIP 34613
Phone: (352) 592-7310
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LARGO PHYSICIAN GROUP, LLC is a pediatrics in Brooksville, FL. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. LARGO PHYSICIAN GROUP, LLC NPI is 1578732889. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

11373 CORTEZ BLVD STE 408
BROOKSVILLE, FL
ZIP 34613-406
Phone: (352) 592-7310

The provider's authorized official is William Tedrick Johnson .
The authorized official title is Division Vp/ao and has the following contact phone number (615) 372-3375.

The CLIA number assigned to this NPI record is 10D2113641 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/21/2008 and was last updated on 10/21/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1000757301OTHERFLORIDAMEDICAID-WALSINGHAM LOCATION
272062AOTHERFLORIDABCBS FL-WALSINGHAM
3000757300OTHERFLORIDAMEDICAID --INDIAN ROCKS LOCATION
472062OTHERFLORIDABCBS FL--INDIAN ROCKS
5000757303OTHERFLORIDAMEDICAID-BARDMOOR LOCATION
676062COTHERFLORIDABCBS FL-- BARDMOOR
772062BOTHERFLORIDABCBS FL--38TH AVE N.

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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