Healthcare Provider Details

I. General information

NPI: 1265820823
Provider Name (Legal Business Name): PATTON MEDICAL OF THE GULF COAST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 OLD SHELL RD
MOBILE AL
36607-3416
US

IV. Provider business mailing address

3002 BIENVILLE BLVD SUITE C
OCEAN SPRINGS MS
39564-4354
US

V. Phone/Fax

Practice location:
  • Phone: 251-459-8600
  • Fax: 228-872-8686
Mailing address:
  • Phone: 228-872-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM KEITH WADE
Title or Position: OWNER VP
Credential:
Phone: 228-872-8685