Provider Demographics
NPI:1447357652
Name:GULF COAST LUNG AND SLEEP MEDICINE INSTITUTE, LLC
Entity type:Organization
Organization Name:GULF COAST LUNG AND SLEEP MEDICINE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDMUNDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUBIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-831-3013
Mailing Address - Street 1:16120 LANDON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-6119
Mailing Address - Country:US
Mailing Address - Phone:228-381-3013
Mailing Address - Fax:228-831-3348
Practice Address - Street 1:16120 LANDON RD
Practice Address - Street 2:SUITE B
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-6119
Practice Address - Country:US
Practice Address - Phone:228-381-3013
Practice Address - Fax:228-831-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty