Provider Demographics
NPI:1821460973
Name:GULF COAST SURGICAL CONSULTANTS LLC
Entity Type:Organization
Organization Name:GULF COAST SURGICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTELL
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:214-227-2457
Mailing Address - Street 1:1196 SPRINGWATER DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-7434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:1196 SPRINGWATER DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-7434
Practice Address - Country:US
Practice Address - Phone:214-227-2457
Practice Address - Fax:214-764-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15-493163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty