Healthcare Provider Details

I. General information

NPI: 1154575934
Provider Name (Legal Business Name): GULF COAST HOSPITAL LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HWY 59 BYPASS
WHARTON TX
77488
US

IV. Provider business mailing address

PO BOX 848487
DALLAS TX
75284
US

V. Phone/Fax

Practice location:
  • Phone: 979-282-6100
  • Fax: 979-282-6190
Mailing address:
  • Phone: 979-282-6100
  • Fax: 979-282-6190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number008330
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number008330
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number008330
License Number StateTX

VIII. Authorized Official

Name: MRS. NANCY S MONTELLO
Title or Position: DIRECTOR OF BUSINESS OFFICE
Credential:
Phone: 979-282-6141