Provider Demographics
NPI:1669630604
Name:GULF COAST RHEUMATOLOGY
Entity Type:Organization
Organization Name:GULF COAST RHEUMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:P
Authorized Official - Last Name:SEDRISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-646-2223
Mailing Address - Street 1:1051 GAUSE BLVD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-646-2223
Mailing Address - Fax:985-643-1722
Practice Address - Street 1:1051 GAUSE BLVD
Practice Address - Street 2:SUITE 440
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-646-2223
Practice Address - Fax:985-643-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
55080Medicare UPIN
LA55079Medicare UPIN