1164476867 NPI number — SUN CITY HOSPITAL INC

Table of content: (NPI 1164476867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164476867 NPI number — SUN CITY HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUN CITY HOSPITAL INC
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:
HCA FLORIDA SOUTH SHORE HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1164476867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4016 SUN CITY CENTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUN CITY CENTER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33573-5256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-634-3301
Provider Business Mailing Address Fax Number:
813-634-8712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4016 STATE ROAD 674
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUN CITY CENTER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33573-5256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-634-3301
Provider Business Practice Location Address Fax Number:
813-634-8712
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
813-634-3301

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11639B , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 580 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0068900 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30021737 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000037941 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000810774X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011994600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01344325 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 031149000 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 304862776 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20670 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0259N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20670 . This is a "WELLCARE/STAYWELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88409 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 960107 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000037680 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 404862785 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99605 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011994600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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