Provider Demographics
NPI:1093065567
Name:GULF BANK MEDICAL CENTER
Entity Type:Organization
Organization Name:GULF BANK MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERSHIP/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD P A
Authorized Official - Phone:281-447-7614
Mailing Address - Street 1:302 W GULF BANK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-2365
Mailing Address - Country:US
Mailing Address - Phone:281-447-7614
Mailing Address - Fax:281-447-6514
Practice Address - Street 1:302 W GULF BANK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-2365
Practice Address - Country:US
Practice Address - Phone:281-447-7614
Practice Address - Fax:281-447-6514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3116302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126942501Medicaid
TX126942501Medicaid
TX00A38SMedicare PIN