| Entity Name: | SCC GROUP HEALTH CLINIC INCORPORATED |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Mar 1988 (37 years ago) |
| Document Number: | K18655 |
| FEI/EIN Number | 592878713 |
| Address: | 1601 RICKENBACKER DRIVE, SUITE #2, SUN CITY CENTER, FL, 33573 |
| Mail Address: | 1601 RICKENBACKER DRIVE, SUITE #2, SUN CITY CENTER, FL, 33573 |
| ZIP code: | 33573 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083688485 | 2006-02-14 | 2008-08-20 | 1601 RICKENBACKER DR, SUITE #2, SUN CITY CENTER, FL, 335735332, US | 1601 RICKENBACKER DR, SUITE #2, SUN CITY CENTER, FL, 335735332, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-634-8980 |
| Fax | 8136342593 |
Authorized person
| Name | DR. ALLEN THOMAS ZAK |
| Role | PRESIDENT |
| Phone | 8136348980 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BC/BS PROVIDER NUMBER |
| Number | 22072 |
| State | FL |
| Issuer | MEDICAID |
| Number | 050266900 |
| State | FL |
| Issuer | RAILROAD MEDICARE NUMBER |
| Number | 350013655 |
| State | FL |
| Issuer | UPIN NUMBER |
| Number | T54819 |
| State | FL |
| Issuer | AETNA PROVIDER NUMBER |
| Number | 0009673 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LINSKY, DONALD B. | Agent | 1509 SUN CITY CENTER PLAZA, SUN CITY CENTER, FL, 33573 |
| Name | Role | Address |
|---|---|---|
| ZAK ALLEN T | Director | 8504 DEE CIRCLE, RIVERVIEW, FL, 33569 |
| Name | Role | Address |
|---|---|---|
| ZAK ALLEN T | Treasurer | 8504 DEE CIRCLE, RIVERVIEW, FL, 33569 |
| Name | Role | Address |
|---|---|---|
| ZAK ALLEN T | President | 8504 DEE CIRCLE, RIVERVIEW, FL, 33569 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
