| South Coast Internists | |
|
1340 Broad Ave Suite 310 Gulfport MS 39501-2418 | |
| (228) 864-6629 | |
| (228) 864-6669 |
| Full Name | South Coast Internists |
|---|---|
| Speciality | Internal Medicine |
| Location | 1340 Broad Ave, Gulfport, Mississippi |
| Authorized Official Name and Position | Randy Robinson (ADMINISTRATOR) |
| Authorized Official Contact | 2288651453 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Coast Internists 1612 31st Ave Gulfport MS 39501-2750 Ph: (228) 865-1453 | South Coast Internists 1340 Broad Ave Suite 310 Gulfport MS 39501-2418 Ph: (228) 864-6629 |
| NPI Number | 1922034073 |
|---|---|
| Provider Enumeration Date | 06/23/2006 |
| Last Update Date | 04/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922034073 | NPI | - | NPPES |
| 05900013 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
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