Provider Demographics
NPI:1790984383
Name:GULF COAST MEDICAL EVALUATIONS
Entity Type:Organization
Organization Name:GULF COAST MEDICAL EVALUATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:281-741-4880
Mailing Address - Street 1:2620 CULLEN BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-9008
Mailing Address - Country:US
Mailing Address - Phone:281-741-4880
Mailing Address - Fax:866-200-1827
Practice Address - Street 1:2620 CULLEN BLVD STE 214
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-9008
Practice Address - Country:US
Practice Address - Phone:281-741-4880
Practice Address - Fax:866-200-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9035261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center