Provider Demographics
NPI:1750822342
Name:GULF COAST HEALTH SYSTEM IMAGING, LLC
Entity Type:Organization
Organization Name:GULF COAST HEALTH SYSTEM IMAGING, LLC
Other - Org Name:OPTIMAL IMAGING SACRED HEART HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:615-974-1972
Mailing Address - Street 1:1642 WESTGATE CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8195
Mailing Address - Country:US
Mailing Address - Phone:615-974-1972
Mailing Address - Fax:
Practice Address - Street 1:13137 SORRENTO RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507
Practice Address - Country:US
Practice Address - Phone:615-974-1972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography