Basic Information
| Provider Information | |||||||||
| NPI: | 1205185030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNSTATE MANAGED CARE SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5600 MARINER ST | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336093471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136328861 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5600 MARINER ST | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336093471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136328861 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2012 | ||||||||
| LastUpdateDate: | 09/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | PALAVI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8136328861 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.