Provider Demographics
NPI:1043525546
Name:SUNCOAST SURGICAL ASSISTANTS LLC
Entity Type:Organization
Organization Name:SUNCOAST SURGICAL ASSISTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:TESTERMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA
Authorized Official - Phone:941-400-1901
Mailing Address - Street 1:5824 BEE RIDGE RD
Mailing Address - Street 2:#446
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5065
Mailing Address - Country:US
Mailing Address - Phone:941-400-1901
Mailing Address - Fax:941-379-8219
Practice Address - Street 1:5824 BEE RIDGE RD
Practice Address - Street 2:#446
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5065
Practice Address - Country:US
Practice Address - Phone:941-400-1901
Practice Address - Fax:941-379-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102238363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0391ZMedicare PIN
FLPA84916Medicare UPIN