Organization
GCMC OF WHARTON COUNTY TEXAS, LLC
Active
Other names
Gulf Coast Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN D CRANDALL (CIO)
(480) 650-7534
Entity
Organization
Contact information
Practice address
10141 US 59 RD, WHARTON, TX 77488-7224
(979) 282-6141
(979) 282-6036
Mailing address
PO BOX 4869, DEPT 407A, HOUSTON, TX 77210-4869
(480) 650-7534
(480) 219-5572
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
008330
TX
282N00000X
General Acute Care Hospital
Primary
100142
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014503
TDH BUREAU OF KIDNEY HLTH
TX
05
—
1363335 04
—
TX
05
—
1363335 06
—
TX
01
—
16213213594002
TEXAS REHAB VENDOR #
TX
05
—
178815001
—
TX
05
—
178815002
—
TX
05
—
178815003
—
TX
05
—
178848101
—
TX
01
—
45D0495923
CLIA # FOR LABORATORY
TX
01
—
45D0679101
CLIA # CARDIO BLOOD GAS
TX
01
—
621321359774880000
CHAMPUS PROVIDER #
TX
01
—
HH0522
BLUE CROSS ACUTE
TX
01
—
HH2802
BLUE CROSS SNF
TX
01
—
TAX ID
203745677
TX
Enumeration date
05/24/2005
Last updated
10/18/2016
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