Provider Demographics
NPI:1598704561
Name:SUNCOAST VEIN CARE, INC
Entity type:Organization
Organization Name:SUNCOAST VEIN CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-823-8300
Mailing Address - Street 1:1955 1ST AVE N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8941
Mailing Address - Country:US
Mailing Address - Phone:727-823-8300
Mailing Address - Fax:727-823-0900
Practice Address - Street 1:1955 1ST AVE N
Practice Address - Street 2:SUITE 103
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8941
Practice Address - Country:US
Practice Address - Phone:727-823-8300
Practice Address - Fax:727-823-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME757802085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9580Medicare ID - Type Unspecified