MEDICARE: GULF COAST RESEARCH, LLC

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	293D00000X	Physiological Laboratory
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1669618658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST RESEARCH, LLC

Provider Business Mailing Address
First Line	:	7049 PERKINS RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4320
Country	:	US
Telephone Number	:	225-757-1084
Fax Number	:	225-757-0294

Provider Business Practice Location Address
First Line	:	7049 PERKINS RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4320
Country	:	US
Telephone Number	:	225-757-1084
Fax Number	:	225-757-0294

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID DESHOTELS
Credential	:
Telephone Number	:	225-757-1084

Provider Enumeration Date	:	12/23/2008
Last Update Date	:	12/23/2008

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