Provider Demographics
NPI:1790226934
Name:FLORIDA GULF COAST HEARING CENTER, LLC
Entity Type:Organization
Organization Name:FLORIDA GULF COAST HEARING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:T
Authorized Official - Last Name:CROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:HAS
Authorized Official - Phone:239-514-2419
Mailing Address - Street 1:2180 IMMOKALEE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1422
Mailing Address - Country:US
Mailing Address - Phone:239-514-2419
Mailing Address - Fax:239-514-2280
Practice Address - Street 1:2180 IMMOKALEE RD STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110
Practice Address - Country:US
Practice Address - Phone:239-514-2419
Practice Address - Fax:239-514-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5193261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech