Provider Demographics
NPI:1871992545
Name:SUN CITY CENTER HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:SUN CITY CENTER HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELDRIDGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-331-3940
Mailing Address - Street 1:3040 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-5220
Mailing Address - Country:US
Mailing Address - Phone:813-331-3940
Mailing Address - Fax:813-331-3941
Practice Address - Street 1:3040 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-5220
Practice Address - Country:US
Practice Address - Phone:813-331-3940
Practice Address - Fax:813-331-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58221Medicare UPIN
FL71877Medicare PIN