# SUNCOAST VASCULAR CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164598678
- **Authorized official:** DR. MARC J GOULET MD (CEO)
- **Authorized official phone:** (954) 439-3465

## Contact information

- **Practice address:** 3722 CENTRAL AVE, SUITE 6, FT MYERS, FL 33901-8247
- **Practice address phone:** (239) 277-7700
- **Practice address fax:** (239) 277-7070
- **Mailing address:** 840 US HIGHWAY ONE \#210, ATTN AMBER KENNEDY, NORTH PALM BEACH, FL 33408-3830
- **Mailing address phone:** (561) 626-9021
- **Mailing address fax:** (561) 626-7593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/27/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 50648 | BC BS | FL |