Provider Demographics
NPI:1639478589
Name:SC PHYSICIANS LLC
Entity Type:Organization
Organization Name:SC PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, FPS
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-532-1355
Mailing Address - Street 1:PO BOX 12868
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-2868
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:620 10TH STREET N.
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1407
Practice Address - Country:US
Practice Address - Phone:727-532-1355
Practice Address - Fax:727-266-4928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SC PHYSICIANS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-17
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6564680001Medicare NSC