MEDICARE: GULF COAST WOUND CARE 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1821882820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST WOUND CARE LLC

Provider Business Mailing Address
First Line	:	118 COVINGTON COTTAGE LN
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-8832
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 COVINGTON COTTAGE LN
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-8832
Country	:	US
Telephone Number	:	985-273-0233
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINA HASTINGS
Credential	:
Telephone Number	:	985-273-0233

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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