Healthcare Provider Details

I. General information

NPI: 1821436601
Provider Name (Legal Business Name): GULF COAST MOBILITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 JEFFERSON HWY
JEFFERSON LA
70121-2405
US

IV. Provider business mailing address

1204 JEFFERSON HWY
JEFFERSON LA
70121-2405
US

V. Phone/Fax

Practice location:
  • Phone: 504-838-1566
  • Fax:
Mailing address:
  • Phone: 504-838-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number555030
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number555030
License Number StateLA

VIII. Authorized Official

Name: MR. HAL GIANGROSSO SR.
Title or Position: DIRECTOR
Credential: CAPS
Phone: 504-838-1566