Provider Demographics
NPI:1578297123
Name:GULF COAST HEART AND VASCULAR LLC
Entity type:Organization
Organization Name:GULF COAST HEART AND VASCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-215-6008
Mailing Address - Street 1:1834 LISENBY AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3761
Mailing Address - Country:US
Mailing Address - Phone:850-215-6008
Mailing Address - Fax:850-215-6020
Practice Address - Street 1:1834 LISENBY AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3761
Practice Address - Country:US
Practice Address - Phone:850-215-6008
Practice Address - Fax:850-215-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty