Provider Demographics
NPI:1740288679
Name:GULF COAST SURGICAL PARTNERS LLC
Entity type:Organization
Organization Name:GULF COAST SURGICAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-460-5280
Mailing Address - Street 1:4721 MORRISON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3350
Mailing Address - Country:US
Mailing Address - Phone:251-272-4934
Mailing Address - Fax:251-460-5457
Practice Address - Street 1:3610 SPRINGHILL MEMORIAL DR N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1162
Practice Address - Country:US
Practice Address - Phone:251-410-3800
Practice Address - Fax:251-460-5457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5989261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALASC0071CMedicaid
AL051554502Medicare PIN