Provider Demographics
NPI:1558338319
Name:GULF COAST MEDICAL SPECIALISTS PLLC
Entity type:Organization
Organization Name:GULF COAST MEDICAL SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-379-8481
Mailing Address - Street 1:5831 BEE RIDGE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5088
Mailing Address - Country:US
Mailing Address - Phone:941-379-8481
Mailing Address - Fax:941-379-3781
Practice Address - Street 1:5831 BEE RIDGE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5088
Practice Address - Country:US
Practice Address - Phone:941-379-8481
Practice Address - Fax:941-379-3781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258763700Medicaid
FL38702OtherBCBS
FLCH1204OtherRR MEDICARE
FL38702OtherBCBS
FL38702OtherBCBS