| Gulf Coast Neurospa Llc | |
|
8845 Lorraine Road Gulfport MS 39503 | |
| (228) 277-1771 | |
| (866) 740-0655 |
| Full Name | Gulf Coast Neurospa Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 8845 Lorraine Road, Gulfport, Mississippi |
| Authorized Official Name and Position | Bryan Vyverberg (OWNER) |
| Authorized Official Contact | 2282771771 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Neurospa Llc 8845 Lorraine Road Gulfport MS 39503 Ph: (228) 277-1771 | Gulf Coast Neurospa Llc 8845 Lorraine Road Gulfport MS 39503 Ph: (228) 277-1771 |
| NPI Number | 1013515451 |
|---|---|
| Provider Enumeration Date | 10/16/2020 |
| Last Update Date | 04/25/2023 |
| Certification Date | 04/25/2023 |
| Medicare PECOS PAC ID | 5092184622 |
|---|---|
| Medicare Enrollment ID | O20221202002848 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013515451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Bryan Vyverberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740272723 PECOS PAC ID: 1052604824 Enrollment ID: I20160801002531 |
| Provider Name | Scott Joseph Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548514151 PECOS PAC ID: 6204188436 Enrollment ID: I20181016002358 |
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