Provider Demographics
NPI:1720277445
Name:GULF COAST PSYCHIATRIC CARE
Entity type:Organization
Organization Name:GULF COAST PSYCHIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERA
Authorized Official - Middle Name:K
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-696-9224
Mailing Address - Street 1:421 DELMAS AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-4136
Mailing Address - Country:US
Mailing Address - Phone:228-696-9224
Mailing Address - Fax:228-696-9228
Practice Address - Street 1:421 DELMAS AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-4136
Practice Address - Country:US
Practice Address - Phone:228-696-9224
Practice Address - Fax:228-696-9228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GULF COAST PSYCHIATRIC CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-18
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS198192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01708228Medicaid
MS427578364OtherBCBS
MS09734214OtherMEDICAID GROUP NUMBER
MS512G700103Medicare PIN