Provider Demographics
NPI:1992183545
Name:SUNCOAST VASCULAR & GENERAL SURGERY PA
Entity Type:Organization
Organization Name:SUNCOAST VASCULAR & GENERAL SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:GELINAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-794-6191
Mailing Address - Street 1:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-1085
Mailing Address - Country:US
Mailing Address - Phone:352-794-6191
Mailing Address - Fax:352-794-6193
Practice Address - Street 1:11535 W EMERALD OAKS DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-2815
Practice Address - Country:US
Practice Address - Phone:352-794-6191
Practice Address - Fax:352-794-6193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8292208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty