| Gulfcoast Healthcare Group Llc | |
|
2721 Del Prado Blvd S Ste 250 Cape Coral FL 33904-5710 | |
| (239) 574-5559 | |
| (239) 574-9454 |
| Full Name | Gulfcoast Healthcare Group Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2721 Del Prado Blvd S Ste 250, Cape Coral, Florida |
| Authorized Official Name and Position | Larry Dean Johnson (PRESIDENT) |
| Authorized Official Contact | 2395745559 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulfcoast Healthcare Group Llc 2721 Del Prado Blvd S Ste 250 Cape Coral FL 33904-5710 Ph: (239) 574-5559 | Gulfcoast Healthcare Group Llc 2721 Del Prado Blvd S Ste 250 Cape Coral FL 33904-5710 Ph: (239) 574-5559 |
| NPI Number | 1215788229 |
|---|---|
| Provider Enumeration Date | 03/28/2024 |
| Last Update Date | 04/05/2024 |
| Medicare PECOS PAC ID | 9335684570 |
|---|---|
| Medicare Enrollment ID | O20240712000608 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215788229 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Aaron A Wohl |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174636724 PECOS PAC ID: 2466429204 Enrollment ID: I20040913000395 |
| Provider Name | Suzanne N Bryce |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326338591 PECOS PAC ID: 6901047141 Enrollment ID: I20170425002923 |
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