Provider Demographics
NPI:1598118176
Name:GULF COAST MRI LLC
Entity Type:Organization
Organization Name:GULF COAST MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-521-1961
Mailing Address - Street 1:116 S PINELLAS AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3632
Mailing Address - Country:US
Mailing Address - Phone:727-934-0513
Mailing Address - Fax:727-934-0514
Practice Address - Street 1:116 S PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3632
Practice Address - Country:US
Practice Address - Phone:727-934-0513
Practice Address - Fax:727-934-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)