Provider Demographics
NPI:1578661435
Name:SUNCOAST LUNG CENTER
Entity Type:Organization
Organization Name:SUNCOAST LUNG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-923-8353
Mailing Address - Street 1:3920 BEE RIDGE RD
Mailing Address - Street 2:BLDG C STE C
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1207
Mailing Address - Country:US
Mailing Address - Phone:941-923-8353
Mailing Address - Fax:941-925-7064
Practice Address - Street 1:3920 BEE RIDGE RD
Practice Address - Street 2:BLDG C STE C
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1207
Practice Address - Country:US
Practice Address - Phone:941-923-8353
Practice Address - Fax:941-925-7064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253405300Medicaid
FL40164Medicare ID - Type Unspecified