MEDICARE: SUN CITY CENTER HEALTH AND WELLNESS 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1871992545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN CITY CENTER HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	3040 E COLLEGE AVE
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-5220
Country	:	US
Telephone Number	:	813-331-3940
Fax Number	:	813-331-3941

Provider Business Practice Location Address
First Line	:	3040 E COLLEGE AVE
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-5220
Country	:	US
Telephone Number	:	813-331-3940
Fax Number	:	813-331-3941

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ELDRIDGE MCCORMICK
Credential	:	MD
Telephone Number	:	813-331-3940

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	08/28/2014

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