Provider Demographics
NPI:1124205109
Name:GULFSHORE SERVICES INC
Entity Type:Organization
Organization Name:GULFSHORE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARJINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-617-5300
Mailing Address - Street 1:4900 MEDICAL DR
Mailing Address - Street 2:APT # 1409
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5389
Mailing Address - Country:US
Mailing Address - Phone:210-692-9915
Mailing Address - Fax:
Practice Address - Street 1:401 SOUTH PADRE ISLAND ROAD
Practice Address - Street 2:SUIT 102
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405
Practice Address - Country:US
Practice Address - Phone:361-826-5227
Practice Address - Fax:361-826-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX PAYER NO.