Provider Demographics
NPI:1316347263
Name:SUNCOAST MEDICAL CENTERS OF SW FL LLC
Entity type:Organization
Organization Name:SUNCOAST MEDICAL CENTERS OF SW FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:BALDIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOPEZ ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-852-5705
Mailing Address - Street 1:1154 LEE BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4852
Mailing Address - Country:US
Mailing Address - Phone:347-852-5705
Mailing Address - Fax:
Practice Address - Street 1:1154 LEE BLVD
Practice Address - Street 2:STE 4
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4852
Practice Address - Country:US
Practice Address - Phone:347-852-5705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty