=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396694535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNCOAST COMMUNITY HEALTH CENTERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2026
-----------------------------------------------------
Last Update Date | 01/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10334 WHITE VIBURNUM WAY
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33578-5489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-653-6100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 S LAKEWOOD DR
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-2815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-349-7900
-----------------------------------------------------
Fax | 813-349-7900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | SUSAN PELTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-215-2867
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------