1275576431 NPI number — SIGNATURE GULF COAST HOSPITAL LP

Table of content: (NPI 1275576431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275576431 NPI number — SIGNATURE GULF COAST HOSPITAL LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIGNATURE GULF COAST HOSPITAL LP
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:
GULF COAST MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1275576431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848487
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-8487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-282-6141
Provider Business Mailing Address Fax Number:
979-282-6036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10141 US 59 RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHARTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77488-7224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-282-6141
Provider Business Practice Location Address Fax Number:
979-282-6036
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONTELLO
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR OF BUSINESS SERVICES
Authorized Official Telephone Number:
979-282-6141

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  008330 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 178815003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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