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General NPI Number Information
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NPI Number | 1124636196
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Entity Type | Organization
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Legal Business Name | SUNCOAST INTEGRATED MEDICAL CENTER LLC
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Dates
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Enumeration Date | 07/16/2020
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 3840 COLONIAL BLVD STE 1
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City | FORT MYERS
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State | FL
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Zip | 33966-1126
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Country | US
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Telephone | 855-778-6262
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Fax | 855-778-3262
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Provider Business Mailing Address
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Address Line | 3840 COLONIAL BLVD STE 1
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City | FORT MYERS
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State | FL
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Zip | 33966-1126
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Country | US
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Telephone | 855-778-6262
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Fax |
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Authorized Official
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Title or Position | COO
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Name | SCOTT WINFIELD WADMAN
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Credential |
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Telephone | 855-778-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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