Provider Demographics
NPI:1770647588
Name:SUN COAST HOSPITAL INC
Entity Type:Organization
Organization Name:SUN COAST HOSPITAL INC
Other - Org Name:SUN COAST FAMILY CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-586-7164
Mailing Address - Street 1:PO BOX 409841
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9841
Mailing Address - Country:US
Mailing Address - Phone:727-593-5492
Mailing Address - Fax:
Practice Address - Street 1:13540 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3546
Practice Address - Country:US
Practice Address - Phone:727-593-5492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN COAST HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-19
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77073OtherBCBS GROUP NUMBER
FL0015Medicare PIN