Organization
SUNCOAST MEDICAL CLINIC LLC
Active
Organization
SUNCOAST MEDICAL CLINIC LLC
Active
Parent organization
SUNCOAST MEDICAL CLINIC LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNCOAST MEDICAL CLINIC LLC
Authorized official
GEORGE L ETTEL M.D. (PRESIDENT)
(727) 894-1818
Entity
Organization
Contact information
Practice address
601 7TH ST S, ST PETERSBURG, FL 33701-4704
(727) 894-1818
(727) 824-3132
Mailing address
601 7TH ST S, ST PETERSBURG, FL 33701-4704
(727) 894-1818
(727) 824-3132
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y901Q
BCBS
FL
Enumeration date
05/21/2009
Last updated
05/21/2009
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