| Gsw Medical, Llc | |
|
4500 13th St Fl 3 Gulfport MS 39501-2515 | |
| (318) 341-2335 | |
| Not Available |
| Full Name | Gsw Medical, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4500 13th St Fl 3, Gulfport, Mississippi |
| Authorized Official Name and Position | John Nolan Grady (MEMBER) |
| Authorized Official Contact | 3183412335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gsw Medical, Llc 7470 Woodlawn Ct Pass Christian MS 39571-5539 Ph: (318) 341-2335 | Gsw Medical, Llc 4500 13th St Fl 3 Gulfport MS 39501-2515 Ph: (318) 341-2335 |
| NPI Number | 1336885557 |
|---|---|
| Provider Enumeration Date | 05/10/2022 |
| Last Update Date | 05/10/2022 |
| Medicare PECOS PAC ID | 1850779307 |
|---|---|
| Medicare Enrollment ID | O20220613000275 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336885557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Charles A Stanich |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356424576 PECOS PAC ID: 3577563139 Enrollment ID: I20070104000171 |
| Provider Name | Joel Watts |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639359268 PECOS PAC ID: 3476627738 Enrollment ID: I20080805000061 |
| Provider Name | John N Grady |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871933291 PECOS PAC ID: 0143547190 Enrollment ID: I20160811000458 |
| Provider Name | Brittany Stewart Everhart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891289955 PECOS PAC ID: 6305193152 Enrollment ID: I20180725000380 |
| Provider Name | Heather Lyn Jeffrey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003497587 PECOS PAC ID: 8426457730 Enrollment ID: I20210518002537 |
| Provider Name | Kim T Le |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346994183 PECOS PAC ID: 3173917770 Enrollment ID: I20220224001833 |
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