Provider Demographics
NPI:1376618918
Name:SUNCOAST MEDICAL IMAGING ASSOCIATES
Entity Type:Organization
Organization Name:SUNCOAST MEDICAL IMAGING ASSOCIATES
Other - Org Name:SCMI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUDELKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-446-5150
Mailing Address - Street 1:PO BOX 1391
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33779-1391
Mailing Address - Country:US
Mailing Address - Phone:727-446-5150
Mailing Address - Fax:727-446-6889
Practice Address - Street 1:2025 INDIAN ROCKS RD S
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1035
Practice Address - Country:US
Practice Address - Phone:727-446-5150
Practice Address - Fax:727-446-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99746OtherGROUP PIN NUMBER