MEDICARE: SUNCOAST UR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME53533	FL

General Provider Information

NPI Number	:	1679581722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST UR LLC

Provider Business Mailing Address
First Line	:	4144 N ARMENIA AVE
Second Line	:	SUITE 301
City	:	TAMPA
State	:	FL
Zip	:	33607-6400
Country	:	US
Telephone Number	:	813-875-0122
Fax Number	:	813-875-0208

Provider Business Practice Location Address
First Line	:	4144 N ARMENIA AVE
Second Line	:	SUITE 301
City	:	TAMPA
State	:	FL
Zip	:	33607-6400
Country	:	US
Telephone Number	:	813-875-0122
Fax Number	:	813-875-0208

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARLENE M MARTINEZ
Credential	:	M.D.
Telephone Number	:	813-875-0122

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/01/2007

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