Provider Demographics
NPI:1740385632
Name:GULF COAST OUTPATIENT SURGERY CENTER LLC
Entity Type:Organization
Organization Name:GULF COAST OUTPATIENT SURGERY CENTER LLC
Other - Org Name:GULF COAST OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-594-2904
Mailing Address - Street 1:2781 C T SWITZER SR DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4536
Mailing Address - Country:US
Mailing Address - Phone:228-594-2900
Mailing Address - Fax:
Practice Address - Street 1:2781 C.T. SWITZER SR DIRVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4535
Practice Address - Country:US
Practice Address - Phone:228-594-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS022261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS490000042Medicare PIN