Basic Information
| Provider Information | |||||||||
| NPI: | 1932290707 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GULF COAST REHAB EQUIPMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2070 LITTLE HILLS EXPY | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633013708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144477500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2712 7TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352333406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516661055 | ||||||||
| FaxNumber: | 2516668661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 03/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER OF CREDENTIALAND LICENSURE | ||||||||
| AuthorizedOfficialTelephone: | 3144477515 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | 145 | AL | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.