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General NPI Number Information
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NPI Number | 1184049561
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Entity Type | Organization
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Legal Business Name | GULF COAST INTERVENTIONAL PAIN MANAGEMENT CLINIC, INC
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Dates
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Enumeration Date | 02/21/2014
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Last Update Date | 02/21/2014
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Provider Practice Location Address
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Address Line | 11010 DAVID ST SUITE B
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City | GULFPORT
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State | MS
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Zip | 39503-3481
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Country | US
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Telephone | 228-284-1642
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Fax | 228-284-1643
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Provider Business Mailing Address
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Address Line | 11010 DAVID ST SUITE B
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City | GULFPORT
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State | MS
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Zip | 39503-3481
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Country | US
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Telephone | 228-284-1642
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Fax | 228-284-1643
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAWN XUN MEI
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Credential | M.D.
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Telephone | 228-284-1642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | BM8022149
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 18456
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License Number State | MS
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