Provider Demographics
NPI:1255622833
Name:GULF COAST HEALTH TRAVEL AND IMMUNIZATION
Entity type:Organization
Organization Name:GULF COAST HEALTH TRAVEL AND IMMUNIZATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:941-362-0304
Mailing Address - Street 1:2195 RINGLING BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-7003
Mailing Address - Country:US
Mailing Address - Phone:941-362-0304
Mailing Address - Fax:941-362-0593
Practice Address - Street 1:2195 RINGLING BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7003
Practice Address - Country:US
Practice Address - Phone:941-362-0304
Practice Address - Fax:941-362-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center