Provider Demographics
NPI:1720834575
Name:GULF COAST CONCIERGE, LLC
Entity type:Organization
Organization Name:GULF COAST CONCIERGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:FEDELEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-580-6390
Mailing Address - Street 1:9150 GALLERIA CT STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4379
Mailing Address - Country:US
Mailing Address - Phone:239-580-6390
Mailing Address - Fax:833-941-4948
Practice Address - Street 1:9150 GALLERIA CT STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4379
Practice Address - Country:US
Practice Address - Phone:239-580-6390
Practice Address - Fax:833-941-4948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty