MEDICARE: SCC GROUP HEALTH CLINIC INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	350013655	OTHER	FL	RAILROAD MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22072	OTHER	FL	BC/BS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	T54819	OTHER	FL	UPIN NUMBER
5	0009673	OTHER	FL	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1083688485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCC GROUP HEALTH CLINIC INCORPORATED

Provider Business Mailing Address
First Line	:	1601 RICKENBACKER DR
Second Line	:	SUITE #2
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5332
Country	:	US
Telephone Number	:	813-634-8980
Fax Number	:	813-634-2593

Provider Business Practice Location Address
First Line	:	1601 RICKENBACKER DR
Second Line	:	SUITE #2
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5332
Country	:	US
Telephone Number	:	813-634-8980
Fax Number	:	813-634-2593

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALLEN THOMAS ZAK
Credential	:	D.C.
Telephone Number	:	813-634-8980

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	08/20/2008

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