Gulf Coast Neurospa LLC
Organization Active NPI Psychiatry Physician · Gulfport, MS
NPI 1013515451 · NPPES record last updated Apr 25, 2023
Key facts
- NPI
- 1013515451
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- GULF COAST NEUROSPA LLC
- Practice address
- 8845 Lorraine Road
Gulfport, MS 39503 - Phone
- (228) 277-1771
- Fax
- (866) 740-0655
- NPI assigned
- Oct 16, 2020
- Organization subpart
- No
Authorized official
- Name
- Bryan Vyverberg, MD
- Title
- Owner
- Phone
- (228) 277-1771
Member of 1
Practitioners 7
-
Bryan Vyverberg, M.D.
-
Stephen Charles James, M.D.
-
Scott J. Turner, APRN-BC, PMHNP
-
Grace Duff Miller, FNP-C
-
Jeanette Mortara, NURSE PRACTITIONER
-
Marsha Wyatt, LMT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS, FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221202002848 | MS | Part B Supplier - Clinic/Group Practice | 5092184622 |
Receives reassigned benefits from 4 practitioners Practice locations: Gulfport, MS; Ocean Springs, MS |
| O20241023003173 | FL | Part B Supplier - Clinic/Group Practice | 5092184622 |
Receives reassigned benefits from 2 practitioners Practice locations: Pensacola, FL |
National Provider Directory
Locations
812 Creighton Rd
Pensacola, FL 32504
Phone (850) 564-6644
8845 Lorraine Rd
Gulfport, MS 39503
Phone (228) 277-1771
1019 Government St
Ste E
Ocean Springs, MS 39564
Phone (228) 277-1771
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes |
Addresses
Primary practice location
8845 Lorraine Road
Gulfport, MS 39503
Mailing address
8845 Lorraine Road
Gulfport, MS 39503
Phone (228) 277-1771
Other names
- Bridgewater TMS LLC
Other providers in Gulfport, MS
- Gulf Coast Mental Health Center
- Gulf Coast Mental Health Center
- Gulf Coast Mental Health Center
- Gulf Coast Mental Health Center
- Gulf Coast Neuropsychology, LLC
- Gulf Coast Pediatric Care LLC
- Gulf Coast Pediatric Dentistry PLLC
- Gulf Coast Periodontics & Implants LLC
- Gulf Coast Physical Therapy Centers PA
- Gulf Coast Plastic Surgery
All providers in Gulfport, MS · Psychiatry Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.