Provider Demographics
NPI:1295013852
Name:SUNCOAST COMMUNITY HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:SUNCOAST COMMUNITY HEALTH CENTERS, INC
Other - Org Name:BRANDON COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-349-7563
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:FL
Mailing Address - Zip Code:33527-0040
Mailing Address - Country:US
Mailing Address - Phone:813-643-6690
Mailing Address - Fax:
Practice Address - Street 1:125 N MOON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4431
Practice Address - Country:US
Practice Address - Phone:813-643-6690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)