Provider Demographics
NPI:1225200298
Name:GULF COAST MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:GULF COAST MEDICAL MANAGEMENT
Other - Org Name:GULF COAST COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVEED
Authorized Official - Middle Name:
Authorized Official - Last Name:SURAIYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-708-2726
Mailing Address - Street 1:1200 AVENUE G
Mailing Address - Street 2:SUITE# 201
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3765
Mailing Address - Country:US
Mailing Address - Phone:504-708-2726
Mailing Address - Fax:504-324-2229
Practice Address - Street 1:1200 AVENUE G
Practice Address - Street 2:SUITE# 201
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3765
Practice Address - Country:US
Practice Address - Phone:504-708-2726
Practice Address - Fax:504-324-2229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty