Provider Demographics
NPI:1487601233
Name:SUNCOAST PATHOLOGY
Entity type:Organization
Organization Name:SUNCOAST PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-483-3319
Mailing Address - Street 1:446 TAMIAMI TRL S
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2625
Mailing Address - Country:US
Mailing Address - Phone:941-483-3319
Mailing Address - Fax:941-483-3406
Practice Address - Street 1:446 TAMIAMI TRL S
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2625
Practice Address - Country:US
Practice Address - Phone:941-483-3319
Practice Address - Fax:941-483-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800000658207ZC0500X, 207ZD0900X, 207ZI0100X, 207ZP0105X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002870300Medicaid
FL002870300Medicaid