Provider Demographics
NPI:1154575934
Name:GULF COAST HOSPITAL LP
Entity type:Organization
Organization Name:GULF COAST HOSPITAL LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MONTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-282-6141
Mailing Address - Street 1:PO BOX 848487
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284
Mailing Address - Country:US
Mailing Address - Phone:979-282-6100
Mailing Address - Fax:979-282-6190
Practice Address - Street 1:1400 HWY 59 BYPASS
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488
Practice Address - Country:US
Practice Address - Phone:979-282-6100
Practice Address - Fax:979-282-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008330261QA1903X, 282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136333505Medicaid
TX136333503Medicaid
TX136333507Medicaid