Healthcare Provider Details

I. General information

NPI: 1093339046
Provider Name (Legal Business Name): GULF COAST DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SAVOY DR STE 1202
HOUSTON TX
77036-3397
US

IV. Provider business mailing address

PO BOX 735248
DALLAS TX
75373-5248
US

V. Phone/Fax

Practice location:
  • Phone: 480-648-0848
  • Fax:
Mailing address:
  • Phone: 480-648-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JENNA ROSS
Title or Position: PRESIDENT
Credential:
Phone: 480-495-5644