Provider Demographics
NPI:1891951117
Name:GULFCOAST HOME MEDICAL, INC.
Entity Type:Organization
Organization Name:GULFCOAST HOME MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-344-9828
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34451-0444
Mailing Address - Country:US
Mailing Address - Phone:352-344-9828
Mailing Address - Fax:352-341-5096
Practice Address - Street 1:2543 ROSS CLARK CIR STE 4
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4916
Practice Address - Country:US
Practice Address - Phone:334-671-8086
Practice Address - Fax:334-671-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0072741332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies