Provider Demographics
NPI:1083688485
Name:SCC GROUP HEALTH CLINIC INCORPORATED
Entity type:Organization
Organization Name:SCC GROUP HEALTH CLINIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-634-8980
Mailing Address - Street 1:1601 RICKENBACKER DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5332
Mailing Address - Country:US
Mailing Address - Phone:813-634-8980
Mailing Address - Fax:813-634-2593
Practice Address - Street 1:1601 RICKENBACKER DR
Practice Address - Street 2:SUITE #2
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5332
Practice Address - Country:US
Practice Address - Phone:813-634-8980
Practice Address - Fax:813-634-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22072OtherBC/BS PROVIDER NUMBER
FL050266900Medicaid
FL350013655OtherRAILROAD MEDICARE NUMBER
FLT54819OtherUPIN NUMBER
FL0009673OtherAETNA PROVIDER NUMBER
FL22072Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER