Provider Demographics
NPI:1003272899
Name:GULF COAST DIAGNOSTIC SOLUTIONS
Entity Type:Organization
Organization Name:GULF COAST DIAGNOSTIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-799-9064
Mailing Address - Street 1:PO BOX 88210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77288-0210
Mailing Address - Country:US
Mailing Address - Phone:832-973-1625
Mailing Address - Fax:
Practice Address - Street 1:17510 W GRAND PKWY S STE 180
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2647
Practice Address - Country:US
Practice Address - Phone:832-973-1625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty