NPIMap

Organization Active NPI

Gulf Coast Healthcare Systems Inc

  • Specialist
  • Lehigh Acres, FL
National Provider Identifier
1255412730
Registry record updated Sep 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
GULF COAST HEALTHCARE SYSTEMS INC
Practice address
2718 Lee Blvd Ste B
Lehigh Acres, FL 33971-1537
Phone
(239) 325-1310
Fax
(239) 694-9101
NPI assigned
Oct 18, 2006
Last updated
Sep 3, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2009

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

Authorized official

Name
Mr. R Mickey Jones, PT
Title
Ceo
Phone
(239) 325-1310

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH4515 FL
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary
Urgent Care Clinic/Center 261QU0200X ME92874 FL

Addresses

Primary practice location

2718 Lee Blvd Ste B
Lehigh Acres, FL 33971-1537

Mailing address

2718 Lee Blvd Ste B
Lehigh Acres, FL 33971-1537
Phone (239) 325-1210

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080619000387 FL Part B Supplier - Clinic/Group Practice 1951472885 Receives reassigned benefits from 13 practitioners
Practice locations: Lehigh Acres, FL
O20120315000751 FL DME Supplier - Physician - General Practice 1951472885 Practice locations: Lehigh Acres, FL

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

2724 5th St W
Ste B
Lehigh Acres, FL 33971
Phone (230) 303-9298

2724 5th St W
Ste Bc
Lehigh Acres, FL 33971
Phone (239) 303-9298

2724 5th St W
Ste C
Lehigh Acres, FL 33971
Phone (239) 303-9296

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251936000000",
    "number": "1255412730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2718 LEE BLVD STE B",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339711537",
            "telephone_number": "239-325-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2718 LEE BLVD STE B",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339711537",
            "telephone_number": "239-325-1310",
            "fax_number": "239-694-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST HEALTHCARE SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2009-09-03",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "R",
        "authorized_official_middle_name": "MICKEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "239-325-1310",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH4515",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "FL",
            "license": "ME92874",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lehigh Acres, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.