Healthcare Provider Details

I. General information

NPI: 1134497167
Provider Name (Legal Business Name): GULF COAST HEALTHCARE SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 02/06/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 5TH ST W STE B
LEHIGH ACRES FL
33971-1581
US

IV. Provider business mailing address

2724 5TH ST W STE B
LEHIGH ACRES FL
33971-1581
US

V. Phone/Fax

Practice location:
  • Phone: 239-325-1310
  • Fax: 888-803-9101
Mailing address:
  • Phone: 239-325-1310
  • Fax: 888-803-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. MICKEY JONES
Title or Position: CEO
Credential: DPT
Phone: 239-694-9102