1952429326 NPI number — SUNCOAST MEDICAL ASSOCIATES PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952429326 NPI number — SUNCOAST MEDICAL ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCOAST MEDICAL ASSOCIATES PA
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:
1952429326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 DELTONA BLVD
Provider Second Line Business Mailing Address:
SUITE #101
Provider Business Mailing Address City Name:
DELTONA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32725-8017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-574-6079
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 DELTONA BLVD
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
DELTONA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32725-8017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-574-6079
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZAVALA
Authorized Official First Name:
EVA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
386-574-6079

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: K3363 . This is a "MEDICARE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".