1851501019 NPI number — GULF COAST HEALING, P.A.

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 1851501019 NPI number — GULF COAST HEALING, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GULF COAST HEALING, P.A.
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:
1851501019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4949 EVERHART RD
Provider Second Line Business Mailing Address:
STE106
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78411-3949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-814-1873
Provider Business Mailing Address Fax Number:
361-814-1875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4949 EVERHART RD
Provider Second Line Business Practice Location Address:
STE106
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411-3949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-814-1873
Provider Business Practice Location Address Fax Number:
361-814-1875
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BURHANS
Authorized Official First Name:
HARLAN
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
361-814-1873

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7225 , 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: 147116101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669443289 . This is a "NPI HARLAN BURHANS, D.C." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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