1457305302 NPI number — THE GULF COAST CENTER

Table of content: (NPI 1457305302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457305302 NPI number — THE GULF COAST CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GULF COAST CENTER
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:
1457305302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77553-2490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-763-2373
Provider Business Mailing Address Fax Number:
409-763-5538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 ROSENBERG ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77550-1494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-763-2373
Provider Business Practice Location Address Fax Number:
409-763-5538
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WINBURN
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
409-763-2373

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com