Provider Demographics
NPI:1700027976
Name:GULF COAST DME
Entity Type:Organization
Organization Name:GULF COAST DME
Other - Org Name:GULF COAST DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:979-417-4294
Mailing Address - Street 1:480 MARINERS DR
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-2261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:480 MARINERS DR
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-2261
Practice Address - Country:US
Practice Address - Phone:979-417-4294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies