Basic Information
| Provider Information | |||||||||
| NPI: | 1164476867 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUN CITY HOSPITAL INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HCA FLORIDA SOUTH SHORE HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4016 SUN CITY CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY CENTER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335735256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136343301 | ||||||||
| FaxNumber: | 8136348712 | ||||||||
| Practice Location | |||||||||
| Address1: | 4016 STATE ROAD 674 | ||||||||
| Address2: | |||||||||
| City: | SUN CITY CENTER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335735256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136343301 | ||||||||
| FaxNumber: | 8136348712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 03/30/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARVEY | ||||||||
| AuthorizedOfficialFirstName: | BEVERLY | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8136340105 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0068900 | 01 | AETNA | OTHER | 0259N | 05 | AL | MEDICAID | 20670 | 01 | GA | WELLCARE | OTHER | 580 | 01 | FL | BLUE CROSS | OTHER | 000037941 | 01 | FL | HUMANA | OTHER | 30021737 | 01 | PA | KEYSTONE MERCY | OTHER | 304862776 | 05 | MI | MEDICAID | 88409 | 01 | GA | AMERIGROUP | OTHER | 99605 | 05 | TN | MEDICAID | 20670 | 01 | WELLCARE/STAYWELL | OTHER | 031149000 | 01 | BLACK LUNG | OTHER | 404862785 | 05 | MI | MEDICAID | 000000037680 | 05 | IL | MEDICAID | 000810774X | 05 | GA | MEDICAID | 011994600 | 05 | FL | MEDICAID | 01344325 | 05 | NY | MEDICAID | 11639B | 05 | SC | MEDICAID | 960107 | 05 | OH | MEDICAID |