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General NPI Number Information
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NPI Number | 1063915866
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Entity Type | Organization
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Legal Business Name | GULF COAST MEDICAL CENTER
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Dates
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Enumeration Date | 03/18/2018
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Last Update Date | 03/18/2018
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Provider Practice Location Address
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Address Line | 51 HOLMES BLVD STE A
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City | TERRYTOWN
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State | LA
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Zip | 70056-2592
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Country | US
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Telephone | 504-263-5113
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Fax |
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Provider Business Mailing Address
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Address Line | 51 HOLMES BLVD STE A
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City | TERRYTOWN
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State | LA
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Zip | 70056-2592
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES RUSSELL
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Credential |
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Telephone | 985-502-6585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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