Provider Demographics
NPI:1275539157
Name:GULF COAST CARDIOLOGY GRP PLLC
Entity Type:Organization
Organization Name:GULF COAST CARDIOLOGY GRP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:PRADIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORBIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-963-0000
Mailing Address - Street 1:3921 N TWIN CITY HWY
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-2118
Mailing Address - Country:US
Mailing Address - Phone:409-963-0000
Mailing Address - Fax:409-963-1899
Practice Address - Street 1:3921 N TWIN CITY HWY
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2118
Practice Address - Country:US
Practice Address - Phone:409-963-0000
Practice Address - Fax:409-963-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6898207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131523605Medicaid
E19588Medicare UPIN
TX131523605Medicaid