NPIMap

Organization Active NPI

Suncoast Medical Clinic LLC

  • Ambulatory Surgical Clinic/Center
  • St Petersburg, FL
National Provider Identifier
1821115841
Registry record updated May 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
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
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2008

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

Authorized official

Name
George L. Ettel, MD
Title
Physician
Phone
(727) 824-8357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 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

Other identifiers 2

IdentifierTypeStateIssuer
790OtherFLSTATE LICENSE
079192000MedicaidFL

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209945600000",
    "number": "1821115841",
    "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": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2008-05-05",
        "status": "A",
        "authorized_official_last_name": "ETTEL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "727-824-8357",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "790",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079192000",
            "state": "FL"
        }
    ],
    "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 May 5, 2008; 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.