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General NPI Number Information
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NPI Number | 1134497167
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Entity Type | Organization
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Legal Business Name | GULF COAST HEALTHCARE SYSTEMS, INC
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 2724 5TH ST W STE B
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City | LEHIGH ACRES
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State | FL
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Zip | 33971-1581
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Country | US
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Telephone | 239-325-1310
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Fax | 888-803-9101
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Provider Business Mailing Address
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Address Line | 2724 5TH ST W STE B
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City | LEHIGH ACRES
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State | FL
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Zip | 33971-1581
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Country | US
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Telephone | 239-325-1310
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Fax | 888-803-9101
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Authorized Official
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Title or Position | CEO
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Name | DR. MICKEY JONES
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Credential | DPT
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Telephone | 239-694-9102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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