1598719577 NPI number — GPCH-GP, INC.

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 1598719577 NPI number — GPCH-GP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GPCH-GP, 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:
GARDEN PARK 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:
1598719577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1240
Provider Second Line Business Mailing Address:
15200 COMMUNITY ROAD
Provider Business Mailing Address City Name:
GULFPORT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39502-1240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-575-7000
Provider Business Mailing Address Fax Number:
228-575-7114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15200 COMMUNITY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39503-3085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-575-7000
Provider Business Practice Location Address Fax Number:
228-575-7114
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAMAZANI
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
228-575-7005

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 473504 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212525100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1743402 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000020006 . This is a "BCBS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 105944200 . This is a "US DEPT LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00220734 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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