Healthcare Provider Details

I. General information

NPI: 1417556275
Provider Name (Legal Business Name): SUNCOAST COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S LAKEWOOD DR
BRANDON FL
33511-2815
US

IV. Provider business mailing address

13110 ELK MOUNTAIN DR
RIVERVIEW FL
33579-7182
US

V. Phone/Fax

Practice location:
  • Phone: 913-349-7900
  • Fax: 888-853-7318
Mailing address:
  • Phone: 813-349-7588
  • Fax: 813-349-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT RODRIGUEZ
Title or Position: CFO
Credential:
Phone: 813-349-7563