Healthcare Provider Details

I. General information

NPI: 1578062725
Provider Name (Legal Business Name): GULF COAST SLEEP MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 BIENVILLE BLVD. SUITE P
OCEAN SPRINGS MS
39564
US

IV. Provider business mailing address

2112 BIENVILLE BLVD. SUITE P
OCEAN SPRINGS MS
39564
US

V. Phone/Fax

Practice location:
  • Phone: 228-334-5437
  • Fax: 898-855-6495
Mailing address:
  • Phone: 228-334-5437
  • Fax: 898-855-5649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number22165
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number22165
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number22165
License Number StateMS

VIII. Authorized Official

Name: DR. MICHAEL E DARIN
Title or Position: OWNER
Credential: M.D.
Phone: 228-281-0679