Provider Demographics
NPI:1023475985
Name:GULF COAST SURGICAL GROUP, LLC
Entity type:Organization
Organization Name:GULF COAST SURGICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:CONTE
Authorized Official - Last Name:FRATTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-845-1662
Mailing Address - Street 1:2439 COUNTRY PLACE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1163
Mailing Address - Country:US
Mailing Address - Phone:727-845-1662
Mailing Address - Fax:727-264-8869
Practice Address - Street 1:2439 COUNTRY PLACE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1163
Practice Address - Country:US
Practice Address - Phone:727-845-1662
Practice Address - Fax:727-264-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-24
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty