MEDICARE: GULF COAST LUNG 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	207Q00000X	Family Medicine Physician
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1972757383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST LUNG CENTER, INC.

Provider Business Mailing Address
First Line	:	364B FM 1959 RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77034-5414
Country	:	US
Telephone Number	:	281-974-5095
Fax Number	:	281-974-5109

Provider Business Practice Location Address
First Line	:	364B FM 1959 RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77034-5414
Country	:	US
Telephone Number	:	281-974-5095
Fax Number	:	281-974-5109

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JASON HUSBANDS
Credential	:
Telephone Number	:	713-206-7621

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	03/30/2015

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