Healthcare Provider Details

I. General information

NPI: 1558444810
Provider Name (Legal Business Name): GULF COAST REHAB EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 LAKESIDE DR
MOBILE AL
36693-5117
US

IV. Provider business mailing address

805 BROOK ST STE 402
ROCKY HILL CT
06067-3431
US

V. Phone/Fax

Practice location:
  • Phone: 251-666-1055
  • Fax: 251-666-1415
Mailing address:
  • Phone: 314-447-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number145
License Number StateAL

VIII. Authorized Official

Name: WALTER JOHNSON
Title or Position: CREDENTIALING AND LICENSURE MANAGER
Credential:
Phone: 314-447-7515