MEDICARE: GULF COAST HEALTH CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508864216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	2548 MEMORIAL BLVD
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2825
Country	:	US
Telephone Number	:	409-983-1161
Fax Number	:	409-983-4933

Provider Business Practice Location Address
First Line	:	610 STRICKLAND DR STE 380
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-4787
Country	:	US
Telephone Number	:	409-886-4400
Fax Number	:	409-983-4933

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. MARSHA E THIGPEN
Credential	:	MD
Telephone Number	:	409-983-1161

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/21/2022

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