GULF COAST SPINAL & NEUROSURGICAL SPECIALISTS (NPI# 1053699488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053699488 |
| Entity Type | Organization |
| Organization Name | GULF COAST SPINAL & NEUROSURGICAL SPECIALISTS |
| Practice Address |
1340 Broad Ave Suite 440 Gulfport MS 39501-2404 |
| Mailing Address |
Po Box 17708 Hattiesburg MS 39404-7708 |
| Practice Telephone | 2288222117 |
| Mailing Telephone | 6012962552 |
| Mailing Fax Number | 6012962397 |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2011-08-03 |
| Authorized Official Name | BARRY MONDAY (BILLING ADMIN) |
| Authorized Official Telephone | 6012962552 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Street Address |
1340 BROAD AVE SUITE 440 |
| City | GULFPORT |
| State | MS |
| Zip Code | 39501-2404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912904590 | Jesse Pullen Penico | Internal Medicine | 1340 Broad Ave, Suite 300, Gulfport, MS 39501-2404 | 2005-06-28 |
| 1306409040 | Lissa Kelly Baber | Nurse Practitioner | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2019-04-18 |
| 1780191577 | Tbd Acquisition II LLC | Social Worker | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2018-01-03 |
| 1629517115 | Delana Mooney | Nurse Practitioner | 1340 Broad Ave, Suite 450, Gulfport, MS 39501-2404 | 2017-02-16 |
| 1396299590 | Charles Strange | Nurse Practitioner | 1340 Broad Ave, Suite 450, Gulfport, MS 39501-2404 | 2016-08-05 |
| 1942699988 | Beth Ann Gruzinskas | Nurse Practitioner | 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 | 2015-01-14 |
| 1720477714 | Lacey Grimes Lichtenstein | Nurse Practitioner | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2015-01-14 |
| 1669872974 | Jamie B Varnado | Social Worker | 1340 Broad Ave, Ste 410, Gulfport, MS 39501-2404 | 2014-08-25 |
| 1700121209 | Danielle Ronquille Lipski | Occupational Therapist | 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 | 2012-12-10 |
| 1164767778 | Shannon Ann Church | Social Worker | 1340 Broad Ave, Ste 410, Gulfport, MS 39501-2404 | 2012-12-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301632 | Daniel Edward Bloom | Physician Assistant | Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2019-11-25 |
| 1730721374 | Affinity Healthcare LLC | Non-emergency Medical Transport (VAN) | 1822 15th St, Suite 8, Gulfport, MS 39501 | 2019-10-15 |
| 1093361156 | Gulf Coast Companion Care, LLC | Home Health | 1314 Pass Road, Ste B, Gulfport, MS 39501 | 2019-08-14 |
| 1609420991 | Greg Meekin Ent | Otolaryngology | 1201 31st Avenue, Gulfport, MS 39501 | 2019-07-25 |
| 1225681216 | Murphy Chiropractic Gulfport, LLC | Clinic/Center | 2700 25th Ave., Gulfport, MS 39501 | 2019-07-19 |
| 1477022838 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 1110 Broad Street, Suite 300, Gulfport, MS 39501 | 2018-11-15 |
| 1477003028 | Mindful Matters | Nurse Practitioner | 1613 23rd Avenue, Gulfport, MS 39501 | 2016-10-06 |
| 1902294093 | Tangular Barnes | Nurse Practitioner | Gulf Coast Mental Health Center, 1600 Broad Ave, Gulfport, MS 39501 | 2014-12-25 |
| 1487065355 | Huong Nguyen | Pharmacist | 2433 25th Avenue, Gulfport, MS 39501 | 2014-05-14 |
| 1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
| Find all providers in zip 39501 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750390811 | Gulfport Outpatient Surgery Center | Clinic/Center | 1240 Broad Ave, Gulfport, MS 39501-2405 | 2006-08-07 |
| 1154360501 | Gulf South Surgery Center LLC | Clinic/Center | 1206 31st Ave, Gulfport, MS 39501-1804 | 2006-06-04 |
| 1326045444 | Gulfport Surgery Center, LLC | Clinic/Center | 1300 Broad Ave, Gulfport, MS 39501-2404 | 2005-07-05 |
| 1104829597 | Hogan Surgical Center | Clinic/Center | 351 Cowan Rd, Gulfport, MS 39507-2019 | 2005-05-31 |
| 1538338322 | Hogan Surgical Center | Clinic/Center | 351 Cowan Rd, Gulfport, MS 39507-2019 | 2008-02-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497391619 | Madison Spine Surgery Center, LLC | Clinic/Center | 160 Fountains Blvd Ste C, Madison, MS 39110-6380 | 2019-11-22 |
| 1588224802 | Flowood Surgery Center LLC | Clinic/Center | 120 Stone Creek Blvd Ste 400, Flowood, MS 39232-8210 | 2019-06-18 |
| 1912480070 | Sog Surgery Center LLC | Clinic/Center | 1211 S Gloster St Ste B, Tupelo, MS 38801-6535 | 2018-09-13 |
| 1942793823 | Starkville Surgery Center LLC | Clinic/Center | 110 Walker Way, Starkville, MS 39759-6607 | 2018-06-14 |
| 1194214510 | Specialty Surgery & Laser Center | Clinic/Center | 306 Bradley Rd Ste A, Corinth, MS 38834-7047 | 2018-05-02 |
| 1154867562 | Urologic Ambulatory Surgery Center, LLC | Clinic/Center | 3353 N Gloster Street, Suite 300, Tupelo, MS 38804 | 2017-01-09 |
| 1205218690 | Nurse Practitioner Professionals, Pllc | Clinic/Center | 427 Highway 51 Se, Kings Daughters Medical Center-wound Healing Center, Brookhaven, MS 39601 | 2015-06-23 |
| 1093121196 | Gulf Coast Outpatient Surgery Center, LLC | Clinic/Center | 2781 Ct Senior Switzer Drive, Suite 101, Biloxi, MS 39531 | 2014-07-09 |
| 1487094058 | Comprehensive Pain Center for Surgery | Clinic/Center | 129 Fountains Blvd., Madison, MS 39110 | 2013-06-27 |
| 1821336371 | Eyecare Surgery Center, LLC | Clinic/Center | 1501 Lakeland Dr Ste 101, Jackson, MS 39216-4839 | 2013-01-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.