Provider Demographics
NPI: | 1710569462 |
---|---|
Name: | SUNCOAST FAMILY WELLNESS LLC |
Entity Type: | Organization |
Organization Name: | SUNCOAST FAMILY WELLNESS LLC |
Other - Org Name: | SUNCOAST FAMILY WELLNESS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DO / OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | BARBARA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BAKUS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 440-991-6718 |
Mailing Address - Street 1: | 6260 LAKE OSPREY DR |
Mailing Address - Street 2: | |
Mailing Address - City: | LAKEWOOD RANCH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34240-8425 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 444-991-6718 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6266 LAKE OSPREY DR |
Practice Address - Street 2: | |
Practice Address - City: | LAKEWOOD RANCH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34240-8425 |
Practice Address - Country: | US |
Practice Address - Phone: | 941-867-2560 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | SUNCOAST FAMILY WELLNESS LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2021-04-22 |
Last Update Date: | 2022-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |