Provider Demographics
NPI:1972571719
Name:GULF COAST MEDICAL EQUIPMENT CO LLC
Entity Type:Organization
Organization Name:GULF COAST MEDICAL EQUIPMENT CO LLC
Other - Org Name:NATIONAL DURABLE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-396-2590
Mailing Address - Street 1:8660 S PEORIA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-2827
Mailing Address - Country:US
Mailing Address - Phone:918-528-3832
Mailing Address - Fax:888-492-4132
Practice Address - Street 1:8660 S PEORIA AVE STE D
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-2827
Practice Address - Country:US
Practice Address - Phone:918-528-3832
Practice Address - Fax:888-492-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 332BX2000X, 335E00000X
LA16186548332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200608510AMedicaid
LA1972571719OtherNPI
LA1110981Medicaid
LA1972571719OtherNPI