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General NPI Number Information
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NPI Number | 1992183545
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Entity Type | Organization
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Legal Business Name | SUNCOAST VASCULAR & GENERAL SURGERY PA
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 11535 W EMERALD OAKS DR
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-2815
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Country | US
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Telephone | 352-794-6191
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Fax | 352-794-6193
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Provider Business Mailing Address
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Address Line | PO BOX 1085
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City | CRYSTAL RIVER
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State | FL
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Zip | 34423-1085
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Country | US
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Telephone | 352-794-6191
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Fax | 352-794-6193
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM R GELINAS
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Credential | D.O.
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Telephone | 352-794-6191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | OS8292
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License Number State | FL
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