Healthcare Provider Details

I. General information

NPI: 1649965963
Provider Name (Legal Business Name): GULF COAST INFUSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N W ST STE 220&230
PENSACOLA FL
32505-1715
US

IV. Provider business mailing address

6565 N W ST STE 220&230
PENSACOLA FL
32505-1715
US

V. Phone/Fax

Practice location:
  • Phone: 850-985-8912
  • Fax: 850-985-8913
Mailing address:
  • Phone: 850-985-8912
  • Fax: 850-985-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TIM MIXON
Title or Position: OWNER
Credential:
Phone: 251-947-5593