Provider Demographics
NPI:1467541839
Name:SAI MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:SAI MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMANUJACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:IYYUNNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-527-2139
Mailing Address - Street 1:PO BOX 24535
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33623-4535
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:
Practice Address - Street 1:3831 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-5601
Practice Address - Country:US
Practice Address - Phone:727-527-2139
Practice Address - Fax:727-522-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45551OtherBCBS
FLCH7631OtherRR MCR LOC 2
FLCH7639OtherRR MCR LOC 1
FLK1932Medicare PIN