Provider Demographics
NPI:1760841043
Name:GULF BEND MGMR CENTER
Entity Type:Organization
Organization Name:GULF BEND MGMR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEISSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-575-0611
Mailing Address - Street 1:6502 NURSERY DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1178
Mailing Address - Country:US
Mailing Address - Phone:361-575-0611
Mailing Address - Fax:361-575-0626
Practice Address - Street 1:6502 NURSERY DRIVE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904
Practice Address - Country:US
Practice Address - Phone:361-575-0611
Practice Address - Fax:361-575-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center