Provider Demographics
NPI:1750571170
Name:GULF COAST CHILDREN'S CLINIC, PA
Entity type:Organization
Organization Name:GULF COAST CHILDREN'S CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OBAID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-875-0780
Mailing Address - Street 1:3650 GROVELAND RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5753
Mailing Address - Country:US
Mailing Address - Phone:228-875-0780
Mailing Address - Fax:228-875-1009
Practice Address - Street 1:3650 GROVELAND RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5753
Practice Address - Country:US
Practice Address - Phone:228-875-0780
Practice Address - Fax:228-875-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center