Provider Demographics
NPI:1447211925
Name:SUNCOAST SURGICAL ASSISTING ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SUNCOAST SURGICAL ASSISTING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:RENSHAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA
Authorized Official - Phone:352-686-3154
Mailing Address - Street 1:8303 BLANTON STREET
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606
Mailing Address - Country:US
Mailing Address - Phone:352-686-3154
Mailing Address - Fax:352-688-2751
Practice Address - Street 1:8303 BLANTON STREET
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606
Practice Address - Country:US
Practice Address - Phone:352-686-3154
Practice Address - Fax:352-688-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-01
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20050027523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB6982OtherRAILROAD MEDICARE
N0997OtherWELL CARE
X1587OtherBLUE CROSS
S85283Medicare UPIN
DB6982OtherRAILROAD MEDICARE