MEDICARE: GULF COAST MEDICAL LOGISTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1043889868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST MEDICAL LOGISTICS

Provider Business Mailing Address
First Line	:	6003 WOODBROOK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-6367
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 NORTH LOOP W STE 510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1531
Country	:	US
Telephone Number	:	713-202-8824
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KRISHNAN SHIVSHANKER
Credential	:
Telephone Number	:	713-202-8824

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	06/24/2021

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Directions to “GULF COAST MEDICAL LOGISTICS ” Practice Location

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