Organization
SUNCOAST MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE L. ETTEL MD (PHYSICIAN)
(727) 824-8357
Entity
Organization
Contact information
Practice address
601 7TH ST S, ST PETERSBURG, FL 33701-4704
(727) 824-8357
(727) 824-3132
Mailing address
601 7TH ST S, ST PETERSBURG, FL 33701-4704
(727) 824-8357
(727) 824-3132
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
790
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079192000
—
FL
01
—
790
STATE LICENSE
FL
Enumeration date
03/23/2007
Last updated
05/05/2008
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