Provider Demographics
NPI:1316901259
Name:GULFCOAST MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:GULFCOAST MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:R
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-791-7404
Mailing Address - Street 1:PO BOX 16851
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-6851
Mailing Address - Country:US
Mailing Address - Phone:727-791-7404
Mailing Address - Fax:727-712-2220
Practice Address - Street 1:2455 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1358
Practice Address - Country:US
Practice Address - Phone:727-791-7404
Practice Address - Fax:727-712-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHME 1411332B00000X
FL32-04508332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4212090001Medicare ID - Type Unspecified