Provider Demographics
NPI:1134497167
Name:GULF COAST HEALTHCARE SYSTEMS, INC
Entity type:Organization
Organization Name:GULF COAST HEALTHCARE SYSTEMS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:239-694-9102
Mailing Address - Street 1:2724 5TH ST W STE B
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1581
Mailing Address - Country:US
Mailing Address - Phone:239-325-1310
Mailing Address - Fax:888-803-9101
Practice Address - Street 1:2724 5TH ST W STE B
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1581
Practice Address - Country:US
Practice Address - Phone:239-325-1310
Practice Address - Fax:888-803-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)