Provider Demographics
NPI:1326016106
Name:GULF COAST OB/GYN, PA
Entity Type:Organization
Organization Name:GULF COAST OB/GYN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-769-1940
Mailing Address - Street 1:4507 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5336
Mailing Address - Country:US
Mailing Address - Phone:228-769-1940
Mailing Address - Fax:228-769-9231
Practice Address - Street 1:4507 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5336
Practice Address - Country:US
Practice Address - Phone:228-769-1940
Practice Address - Fax:228-769-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014392Medicaid
MSC02227Medicare ID - Type Unspecified