MEDICARE: SUNCOAST PRIMARY CARE LLC

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	207R00000X	Internal Medicine Physician	ME96148	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174691448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	7145 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-1048
Country	:	US
Telephone Number	:	352-666-2250
Fax Number	:	352-666-2228

Provider Business Practice Location Address
First Line	:	7145 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-1048
Country	:	US
Telephone Number	:	352-666-2250
Fax Number	:	352-666-2228

Authorized Official
Title or Position	:	MGRM
Name	:	DR. ANITHA KOLLI
Credential	:	M.D.
Telephone Number	:	352-666-2250

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	05/13/2026

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Directions to “SUNCOAST PRIMARY CARE LLC ” Practice Location

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