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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