Provider Demographics
NPI:1265599054
Name:SUNCOAST ORTHOTICS AND PROSTHETICS, INC.
Entity type:Organization
Organization Name:SUNCOAST ORTHOTICS AND PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-493-8288
Mailing Address - Street 1:PO BOX 650846
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0846
Mailing Address - Country:US
Mailing Address - Phone:941-484-2451
Mailing Address - Fax:941-485-2038
Practice Address - Street 1:200 TAMIAMI TRL N STE I
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-1914
Practice Address - Country:US
Practice Address - Phone:941-484-2451
Practice Address - Fax:941-485-2038
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-02
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA201645OtherBLUE CROSS & BLUE SHIELD
FL213266OtherAMERIGROUP
50665OtherAMERICAN BENEFIT
FLM0511OtherBLUE CROSS & BLUE SHIELD
FL027717700Medicaid
50666OtherNORTHWOOD NPN
0260850002Medicare NSC
0260850002Medicare ID - Type Unspecified