Provider Demographics
NPI:1689007080
Name:SUNCOAST COMMUNITY HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:SUNCOAST COMMUNITY HEALTH CENTERS, INC
Other - Org Name:BRANDON COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSDRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-349-7563
Mailing Address - Street 1:125 N MOON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4431
Mailing Address - Country:US
Mailing Address - Phone:813-643-6690
Mailing Address - Fax:
Practice Address - Street 1:125 N MOON AVE STE A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4431
Practice Address - Country:US
Practice Address - Phone:813-643-6690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care