1366809246 NPI number — GULF COAST MEDICAL EVALUATIONS

Table of content: (NPI 1366809246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366809246 NPI number — GULF COAST MEDICAL EVALUATIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GULF COAST MEDICAL EVALUATIONS
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:
6
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:
1366809246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6840 FM 2354 RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEACH CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77523-9191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-754-7397
Provider Business Mailing Address Fax Number:
281-317-8103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3302 MCFADDIN ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77706-5038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-754-7397
Provider Business Practice Location Address Fax Number:
281-317-8103
Provider Enumeration Date:
01/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WOODSON
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-754-7397

Provider Taxonomy Codes

  • Taxonomy code: 111NX0100X , with the licence number:  DC5849TX , 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)





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