1083670871 NPI number — SUNCOAST RADIOLOGY, P.A.

Table of content: (NPI 1083670871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083670871 NPI number — SUNCOAST RADIOLOGY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCOAST RADIOLOGY, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083670871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 MEMORIAL CIRCLE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ORMOND BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32174-5054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-673-8040
Provider Business Mailing Address Fax Number:
386-267-0693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 MEMORIAL CIRCLE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-5054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-673-8040
Provider Business Practice Location Address Fax Number:
386-267-0693
Provider Enumeration Date:
04/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TENER
Authorized Official First Name:
JT
Authorized Official Middle Name:
Authorized Official Title or Position:
HUMAN RESOURCES/CREDENTIALING
Authorized Official Telephone Number:
386-673-8040

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00400 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CB5023 . This is a "RR MEDICARE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CG7286 . This is a "RR MEDICARE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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