NPIMap

Organization Active NPI

Gulf Coast Dermatology & Skin Care Centre

  • Pharmacy
  • Mobile, AL
National Provider Identifier
1184078024
Registry record updated Mar 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
114611 Issued in AL
Legal business name
GULF COAST DERMATOLOGY & SKIN CARE CENTRE
Practice address
580 Providence Park Dr. East
Suite 202
Mobile, AL 36695
Phone
(251) 241-0071
Fax
(251) 202-9163
NPI assigned
Apr 18, 2016
Organization subpart
Yes
Parent organization
GULF COAST DERMATOLOGY & SKIN CARE CENTREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Thomas Bender, M.D.
Title
Managing Officer
Phone
(251) 241-0071

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 114611 AL Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

580 Providence Park Dr. East
Suite 202
Mobile, AL 36695

Mailing address

1620 W. Northwest Highway
Suite 100
Grapevine, TX 76051
Phone (817) 572-0009

Other identifiers 2

IdentifierTypeStateIssuer
189226MedicaidAL
2159548OtherPK

Other names 1

  • Advanced Care Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Gulf Coast Dermatology Skin Care Centre PLLC7 organizations share this tax ID, including this one
Part of
Gulf Coast Dermatology Skin Care Centre PLLC

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

580 Providence Park Dr E
Ste 202
Mobile, AL 36695
Phone (251) 241-0071

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741910400000",
    "number": "1184078024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 W. NORTHWEST HIGHWAY",
            "address_2": "SUITE 100",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "76051",
            "telephone_number": "817-572-0009",
            "fax_number": "817-572-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 PROVIDENCE PARK DR. EAST",
            "address_2": "SUITE 202",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "36695",
            "telephone_number": "251-241-0071",
            "fax_number": "251-202-9163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST DERMATOLOGY & SKIN CARE CENTRE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GULF COAST DERMATOLOGY & SKIN CARE CENTRE",
        "enumeration_date": "2016-04-18",
        "last_updated": "2025-03-14",
        "status": "A",
        "authorized_official_last_name": "BENDER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "MANAGING OFFICER",
        "authorized_official_telephone_number": "251-241-0071",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AL",
            "license": "114611",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189226",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2159548",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Care Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.