MEDICARE: GULF COAST URGENT CARE

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	174400000X	Specialist	00582Z	TX

General Provider Information

NPI Number	:	1215945621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST URGENT CARE

Provider Business Mailing Address
First Line	:	9100 SOUTHWEST FWY
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77074-1519
Country	:	US
Telephone Number	:	713-773-3306
Fax Number	:	713-773-1464

Provider Business Practice Location Address
First Line	:	9100 SOUTHWEST FWY
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77074-1519
Country	:	US
Telephone Number	:	713-773-3306
Fax Number	:	713-773-1464

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JEROME HUTCHENS
Credential	:	MD
Telephone Number	:	713-773-3306

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	08/22/2020

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