1710031984 NPI number — SUNCOAST INTERNAL MEDICINE CONSULTANTS, P.A.

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 1710031984 NPI number — SUNCOAST INTERNAL MEDICINE CONSULTANTS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCOAST INTERNAL MEDICINE CONSULTANTS, 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:
1710031984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13644 WALSINGHAM ROAD
Provider Second Line Business Mailing Address:
S.R. #688
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33774-3532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-595-2519
Provider Business Mailing Address Fax Number:
727-479-0485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13644 WALSINGHAM ROAD
Provider Second Line Business Practice Location Address:
S.R. #688
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33774-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-595-2519
Provider Business Practice Location Address Fax Number:
727-479-0485
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZITO
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
GENERAL PRACTITIONER/PARTNER
Authorized Official Telephone Number:
727-595-2519

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  77021 , 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: 059638800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK1058 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 011007800 . 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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