Healthcare Provider Details

I. General information

NPI: 1831574490
Provider Name (Legal Business Name): GULF COAST HEALTHCARE SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 04/24/2025
Certification Date: 04/16/2025
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

2718 LEE BLVD STE B
LEHIGH ACRES FL
33971-1537
US

V. Phone/Fax

Practice location:
  • Phone: 239-694-9102
  • Fax:
Mailing address:
  • Phone: 239-694-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. RUDOLPH MICKEY JONES
Title or Position: CEO
Credential:
Phone: 239-694-9101