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General NPI Number Information
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NPI Number | 1366922023
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Entity Type | Organization
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Legal Business Name | PHYSICIAN SERVICES OF THE GULF COAST LLC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 921 CEDAR LAKE RD STE E
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City | BILOXI
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State | MS
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Zip | 39532-2126
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Country | US
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Telephone | 228-396-3945
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Fax | 228-396-3946
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Provider Business Mailing Address
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Address Line | PO BOX 7417
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City | DIBERVILLE
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State | MS
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Zip | 39540-7401
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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 | OWNER
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Name | GEORGE LOUKATOS
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Credential | MD
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Telephone | 228-396-3945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | MS
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