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General NPI Number Information
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NPI Number | 1992718795
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Entity Type | Organization
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Legal Business Name | COAST HEART INSTITUTE, PLLC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4215 15TH ST
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City | GULFPORT
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State | MS
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Zip | 39501-2523
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Country | US
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Telephone | 228-863-5211
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Fax |
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Provider Business Mailing Address
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Address Line | 4215 15TH ST
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City | GULFPORT
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State | MS
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Zip | 39501-2523
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Country | US
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Telephone | 228-863-5211
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER/OWNER
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Name | DR. BASSAM R BAROUDI
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Credential | M.D.
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Telephone | 228-863-5211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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