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?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care