Healthcare Provider Details

I. General information

NPI: 1588402341
Provider Name (Legal Business Name): GULF COAST HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MEDICAL CENTER DR
MONROEVILLE AL
36460-3036
US

IV. Provider business mailing address

16 MEDICAL CENTER DR
MONROEVILLE AL
36460-3036
US

V. Phone/Fax

Practice location:
  • Phone: 251-575-1999
  • Fax: 251-239-2678
Mailing address:
  • Phone: 251-571-1999
  • Fax: 251-239-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY BRIGHT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RN
Phone: 251-593-6171