1497776264 NPI number — SUNCOAST VITAL CARE INC

Table of content: (NPI 1497776264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497776264 NPI number — SUNCOAST VITAL CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCOAST VITAL CARE 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:
SUNCOAST VITAL CARE
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:
1497776264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5047
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39302-5047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-447-4095
Provider Business Mailing Address Fax Number:
601-482-7490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
277 W JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34601-2524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-796-1222
Provider Business Practice Location Address Fax Number:
352-796-0017
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VITOLA
Authorized Official First Name:
MONTEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PARNTER
Authorized Official Telephone Number:
352-796-1222

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PH11906 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P6348 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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