Provider Demographics
NPI:1912273285
Name:SUNCOAST COMMUNITY HEALTH CENTERS INC
Entity Type:Organization
Organization Name:SUNCOAST COMMUNITY HEALTH CENTERS INC
Other - Org Name:PLANT CITY FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:813-349-7859
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33575-1349
Mailing Address - Country:US
Mailing Address - Phone:813-349-7649
Mailing Address - Fax:813-349-7629
Practice Address - Street 1:508 N MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3820
Practice Address - Country:US
Practice Address - Phone:813-349-7649
Practice Address - Fax:813-349-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH261783336C0002X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135419OtherPK
FL005932300Medicaid