Provider Demographics
NPI:1386861250
Name:GULF COAST AUDIOLOGY, INC.
Entity Type:Organization
Organization Name:GULF COAST AUDIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:GILL
Authorized Official - Last Name:CRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:228-388-1376
Mailing Address - Street 1:2541 PASS RD STE C
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2112
Mailing Address - Country:US
Mailing Address - Phone:228-388-1376
Mailing Address - Fax:228-388-6359
Practice Address - Street 1:2541 PASS RD STE C
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2112
Practice Address - Country:US
Practice Address - Phone:228-388-1376
Practice Address - Fax:228-388-6359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3139231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty