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General NPI Number Information
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NPI Number | 1497296081
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Entity Type | Organization
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Legal Business Name | GULF COAST HEALTH SYSTEM IMAGING, LLC
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 4033 GULF BREEZE PARKWAY
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City | GULF BREEZE
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State | FL
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Zip | 32561
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Country | US
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Telephone | 615-974-1972
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Fax |
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Provider Business Mailing Address
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Address Line | 1642 WESTGATE CIR STE 202
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City | BRENTWOOD
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State | TN
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Zip | 37027-8195
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Country | US
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Telephone | 615-974-1972
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | MR. RYAN DOUGLAS BROWN
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Credential | JD
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Telephone | 615-974-1972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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