Provider Demographics
NPI:1073535860
Name:GULF COAST LIMB & BRACE
Entity Type:Organization
Organization Name:GULF COAST LIMB & BRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:ORTHOTIST/PROSTHETIS
Authorized Official - Phone:228-864-4512
Mailing Address - Street 1:3506 WASHINGTON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3103
Mailing Address - Country:US
Mailing Address - Phone:228-864-4512
Mailing Address - Fax:228-864-5339
Practice Address - Street 1:3506 WASHINGTON AVE STE D
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3102
Practice Address - Country:US
Practice Address - Phone:228-864-4512
Practice Address - Fax:228-864-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00011709OtherBLUE CROSS
MS00040133Medicaid
MS0152020001Medicare PIN