Provider Demographics
NPI:1922481720
Name:SUNCOAST ENDOSCOPY OF SARASOTA LLC
Entity Type:Organization
Organization Name:SUNCOAST ENDOSCOPY OF SARASOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-952-1145
Mailing Address - Street 1:2089 HAWTHORNE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2308
Mailing Address - Country:US
Mailing Address - Phone:941-952-1145
Mailing Address - Fax:941-952-1175
Practice Address - Street 1:2089 HAWTHORNE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2308
Practice Address - Country:US
Practice Address - Phone:941-952-1145
Practice Address - Fax:941-952-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1146261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10C0001378OtherCMS IDENTIFICATION NUMBER