Provider Demographics
NPI:1316010598
Name:NEUROSCIENCE INSTITUTE OF THE GULF COAST PLLC
Entity type:Organization
Organization Name:NEUROSCIENCE INSTITUTE OF THE GULF COAST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-868-5493
Mailing Address - Street 1:1110 BROAD AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-8908
Mailing Address - Country:US
Mailing Address - Phone:228-868-5493
Mailing Address - Fax:228-868-9930
Practice Address - Street 1:1110 BROAD AVE STE 600
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-8908
Practice Address - Country:US
Practice Address - Phone:228-868-5493
Practice Address - Fax:228-868-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty