Suncoast Integrated Medical Center LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SUNCOAST INTEGRATED MEDICAL CENTER LLC

Practice address

3840 Colonial Blvd Ste 1
Fort Myers, FL 33966-1126

Phone

(855) 778-6262

Fax

(855) 778-3262

NPI assigned

Jul 16, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Scott Winfield Wadman

Title

Coo

Phone

(855) 778-6262

Specialties & licenses 1

Addresses

Other names 1

• Suncoast Regenerative Medical Clinic LLC Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1124636196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3840 COLONIAL BLVD STE 1",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661126",
            "telephone_number": "855-778-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 COLONIAL BLVD STE 1",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661126",
            "telephone_number": "855-778-6262",
            "fax_number": "855-778-3262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "681 Goodlette-Frank Rd N Ste 130",
            "address_purpose": "LOCATION",
            "city": "Naples",
            "state": "FL",
            "postal_code": "341025612",
            "country_code": "US",
            "telephone_number": "855-778-6262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUNCOAST INTEGRATED MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-16",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A",
        "authorized_official_last_name": "WADMAN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "WINFIELD",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "855-778-6262"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suncoast Regenerative Medical Clinic LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Suncoast Vascular Clinic
• Sunevision LLC
• Dorita Sungailaite
• Sunhealth Medical & Rehabilitation Center

• Family Medicine Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.