Provider Demographics
NPI:1649392119
Name:GULFCOAST MEDICAL &GERIATRIC CARE INC
Entity Type:Organization
Organization Name:GULFCOAST MEDICAL &GERIATRIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NANDKISHOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-347-2780
Mailing Address - Street 1:6450 38TH AVE N
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1645
Mailing Address - Country:US
Mailing Address - Phone:727-347-2780
Mailing Address - Fax:727-347-5508
Practice Address - Street 1:6450 38TH AVE N
Practice Address - Street 2:SUITE # 100
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1645
Practice Address - Country:US
Practice Address - Phone:727-347-2780
Practice Address - Fax:727-347-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
21416Medicare ID - Type Unspecified