Provider Demographics
NPI:1134692403
Name:GULF COAST GASTROENTEROLOGY LAB
Entity Type:Organization
Organization Name:GULF COAST GASTROENTEROLOGY LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HUDSON
Authorized Official - Last Name:SWEATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-297-4033
Mailing Address - Street 1:219 OAK DRIVE SOUTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566
Mailing Address - Country:US
Mailing Address - Phone:979-297-4033
Mailing Address - Fax:979-297-0099
Practice Address - Street 1:219 OAK DRIVE SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-297-4033
Practice Address - Fax:979-297-0099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GULF COAST GASTROENTEROLOGY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory