1366922023 NPI number — PHYSICIAN SERVICES OF THE GULF COAST LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366922023 NPI number — PHYSICIAN SERVICES OF THE GULF COAST LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIAN SERVICES OF THE GULF COAST LLC
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:
ALPHACARE URGENT CARE
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:
1366922023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7417
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIBERVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39540-7401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
921 CEDAR LAKE RD STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39532-2126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-396-3945
Provider Business Practice Location Address Fax Number:
228-396-3946
Provider Enumeration Date:
08/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
LOUKATOS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
228-396-3945

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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