Provider Demographics
NPI:1134497167
Name:GULF COAST HEALTHCARE SYSTEMS, INC
Entity Type:Organization
Organization Name:GULF COAST HEALTHCARE SYSTEMS, INC
Other - Org Name:URGENT AND CONVENIENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:MICKEY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:239-325-1310
Mailing Address - Street 1:2718 LEE BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1537
Mailing Address - Country:US
Mailing Address - Phone:239-325-1310
Mailing Address - Fax:888-803-9101
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4440
Practice Address - Country:US
Practice Address - Phone:239-325-1310
Practice Address - Fax:888-803-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health