Provider Demographics
NPI:1992718795
Name:COAST HEART INSTITUTE, PLLC
Entity type:Organization
Organization Name:COAST HEART INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAROUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-863-5211
Mailing Address - Street 1:4215 15TH ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2523
Mailing Address - Country:US
Mailing Address - Phone:228-863-5211
Mailing Address - Fax:
Practice Address - Street 1:4215 15TH ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2523
Practice Address - Country:US
Practice Address - Phone:228-863-5211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty