1114982238 NPI number — GULF MEDICAL SERVICES, INC.

Table of content: (NPI 1114982238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114982238 NPI number — GULF MEDICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GULF MEDICAL SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114982238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3103 N 12TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503-4006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-438-7600
Provider Business Mailing Address Fax Number:
850-438-4138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3103 N 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32503-4006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-438-7600
Provider Business Practice Location Address Fax Number:
850-438-4138
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEBER
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
850-438-7600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  HME112 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X , with the licence number: HME 112 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 026433400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 028315100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8205961 . This is a "UHC PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 59087554 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 027405400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 028316900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: R6206 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P8466 . This is a "BCBS PHARMACY PROV NUM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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