Healthcare Provider Details

I. General information

NPI: 1740843614
Provider Name (Legal Business Name): SUNCOAST PRIMARY CARE VHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5485 FIRETHORN PT
SPRING HILL FL
34609-9512
US

IV. Provider business mailing address

5485 FIRETHORN PT
SPRING HILL FL
34609-9512
US

V. Phone/Fax

Practice location:
  • Phone: 267-393-5265
  • Fax: 888-811-9815
Mailing address:
  • Phone: 267-393-5265
  • Fax: 888-811-9815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SALMAN M MUDDASSIR
Title or Position: OWNER
Credential: MD
Phone: 267-393-5265