Healthcare Provider Details

I. General information

NPI: 1255412730
Provider Name (Legal Business Name): GULF COAST HEALTHCARE SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 239-325-1310
  • Fax: 239-694-9101
Mailing address:
  • Phone: 239-325-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4515
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME92874
License Number StateFL

VIII. Authorized Official

Name: MR. R MICKEY JONES
Title or Position: CEO
Credential: PT
Phone: 239-325-1310