Provider Demographics
NPI:1184677551
Name:GULF COAST PRIMARY CARE PLC
Entity Type:Organization
Organization Name:GULF COAST PRIMARY CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UDAYABHASKER
Authorized Official - Middle Name:
Authorized Official - Last Name:GANGAPURAM REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-847-9505
Mailing Address - Street 1:4807 US HIGHWAY 19 STE 201
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4260
Mailing Address - Country:US
Mailing Address - Phone:727-847-9505
Mailing Address - Fax:727-847-9509
Practice Address - Street 1:4807 US HIGHWAY 19
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4263
Practice Address - Country:US
Practice Address - Phone:727-847-9505
Practice Address - Fax:727-847-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51655YMedicare ID - Type Unspecified