Provider Demographics
NPI:1710586847
Name:GULF COAST HEALTHCARE CENTER, INC.
Entity Type:Organization
Organization Name:GULF COAST HEALTHCARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:MICKEY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-694-9102
Mailing Address - Street 1:PO BOX 1199
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970-1199
Mailing Address - Country:US
Mailing Address - Phone:239-694-9102
Mailing Address - Fax:239-694-9101
Practice Address - Street 1:2724 5TH ST W STE C
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1581
Practice Address - Country:US
Practice Address - Phone:239-303-9296
Practice Address - Fax:239-694-9010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GULF COAST HEALTHCARE SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty