Provider Demographics
NPI:1104039148
Name:GULF COAST SURGICAL GROUP
Entity Type:Organization
Organization Name:GULF COAST SURGICAL GROUP
Other - Org Name:N.H. HEBBAR, M.D. & ARTHUR L. VERGA, M.D., P.A.'S
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:L
Authorized Official - Last Name:VERGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-845-1662
Mailing Address - Street 1:5347 MAIN STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2533
Mailing Address - Country:US
Mailing Address - Phone:727-845-1662
Mailing Address - Fax:727-264-8869
Practice Address - Street 1:5347 MAIN STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2533
Practice Address - Country:US
Practice Address - Phone:727-845-1662
Practice Address - Fax:727-264-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005492700Medicaid
FL38882OtherBLUE SHIELD GROUP
FL38882OtherBLUE SHIELD GROUP