Provider Demographics
NPI:1477613602
Name:GULF COAST DIGESTIVE HEALTH CENTER PL
Entity Type:Organization
Organization Name:GULF COAST DIGESTIVE HEALTH CENTER PL
Other - Org Name:GULF COAST DIGESTIVE HEALTH CENTER PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-936-9186
Mailing Address - Street 1:825 VENETIAN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285
Mailing Address - Country:US
Mailing Address - Phone:941-484-3089
Mailing Address - Fax:941-484-3263
Practice Address - Street 1:825 VENETIAN PARKWAY
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-484-3089
Practice Address - Fax:941-484-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL123456174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFEDERAL TAX NO