NPIMap

Organization Active NPI

Suncoast Medical Clinic LLC

  • Lithotripsy Clinic/Center
  • St Petersburg, FL
National Provider Identifier
1265671812
Registry record updated Feb 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Lithotripsy Clinic/CenterTaxonomy code 261QL0400X
License
790 Issued in FL
Legal business name
SUNCOAST MEDICAL CLINIC LLC
Practice address
601 7TH St S
St Petersburg, FL 33701-4704
Phone
(727) 824-8357
Fax
(727) 824-3132
NPI assigned
Feb 5, 2009
Last updated
Feb 5, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
SUNCOAST MEDICAL CLINIC LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 5, 2009

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

Authorized official

Name
Geroge L Ettel, M.D.
Title
President
Phone
(727) 894-1818

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Lithotripsy Clinic/Center 261QL0400X 790 FL Primary

Addresses

Primary practice location

601 7TH St S
St Petersburg, FL 33701-4704

Mailing address

601 7TH St S
St Petersburg, FL 33701-4704
Phone (727) 824-8357

National Provider Directory

National Provider Directory
Tax ID family
Suncoast Medical Clinic LLC3 organizations share this tax ID, including this one
Part of
Suncoast Medical Clinic LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233792000000",
    "number": "1265671812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 7TH ST S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014704",
            "telephone_number": "727-824-8357",
            "fax_number": "727-824-3132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 7TH ST S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014704",
            "telephone_number": "727-824-8357",
            "fax_number": "727-824-3132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNCOAST MEDICAL CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNCOAST MEDICAL CLINIC LLC",
        "enumeration_date": "2009-02-05",
        "last_updated": "2009-02-05",
        "status": "A",
        "authorized_official_last_name": "ETTEL",
        "authorized_official_first_name": "GEROGE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-894-1818",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QL0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Lithotripsy",
            "state": "FL",
            "license": "790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2009; 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.