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General NPI Number Information
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NPI Number | 1649965963
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Entity Type | Organization
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Legal Business Name | GULF COAST INFUSION LLC
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 6565 N W ST STE 220&230
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City | PENSACOLA
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State | FL
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Zip | 32505-1715
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Country | US
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Telephone | 850-985-8912
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Fax | 850-985-8913
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Provider Business Mailing Address
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Address Line | 6565 N W ST STE 220&230
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City | PENSACOLA
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State | FL
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Zip | 32505-1715
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Country | US
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Telephone | 850-985-8912
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Fax | 850-985-8913
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Authorized Official
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Title or Position | OWNER
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Name | TIM MIXON
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Credential |
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Telephone | 251-947-5593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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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 | 333600000X
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Taxonomy Name | Pharmacy
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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