Provider Demographics
NPI:1184645954
Name:SUNCOAST VITAL CARE INC
Entity Type:Organization
Organization Name:SUNCOAST VITAL CARE INC
Other - Org Name:SUNCOAST VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MONTEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VITOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-796-1222
Mailing Address - Street 1:PO BOX 5047
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5047
Mailing Address - Country:US
Mailing Address - Phone:800-447-4095
Mailing Address - Fax:601-482-7490
Practice Address - Street 1:277 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2524
Practice Address - Country:US
Practice Address - Phone:352-796-1222
Practice Address - Fax:352-796-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 119063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP6348OtherBCBS
FL=========001OtherCHAMPUS/TRICARE
FLP6348OtherBCBS
FL0476460001Medicare NSC