MEDICARE: GULF COAST DME

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1700027976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST DME

Provider Business Mailing Address
First Line	:	480 MARINERS DR
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-2261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 MARINERS DR
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-2261
Country	:	US
Telephone Number	:	979-417-4294
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GEORGE GRIMES
Credential	:	PHD
Telephone Number	:	979-417-4294

Provider Enumeration Date	:	03/17/2009
Last Update Date	:	03/17/2009

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Directions to “GULF COAST DME ” Practice Location

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