Provider Demographics
NPI:1578733614
Name:GULF COAST COMPREHENSIVE CARE LLP
Entity Type:Organization
Organization Name:GULF COAST COMPREHENSIVE CARE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHACE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-473-2913
Mailing Address - Street 1:190 W DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-3237
Mailing Address - Country:US
Mailing Address - Phone:941-473-2913
Mailing Address - Fax:941-473-9813
Practice Address - Street 1:190 W DEARBORN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3237
Practice Address - Country:US
Practice Address - Phone:941-473-2913
Practice Address - Fax:941-473-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5249207Q00000X
FLME48779207R00000X
FLME61249207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty