Provider Demographics
NPI:1043267438
Name:GATEWAY CARDIOLOGY PC
Entity Type:Organization
Organization Name:GATEWAY CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-729-0088
Mailing Address - Street 1:10004 KENNERLY RD STE 185B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2176
Mailing Address - Country:US
Mailing Address - Phone:314-729-0088
Mailing Address - Fax:314-729-3963
Practice Address - Street 1:10004 KENNERLY RD STE 185B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2176
Practice Address - Country:US
Practice Address - Phone:314-729-0088
Practice Address - Fax:314-729-3974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12159OtherMEDICARE
MO12062OtherESSENCE HEALTHCARE
MO39784OtherGROUP HEALTH PLAN
MO4479817OtherAETNA
MO24111584004OtherCIGNA PAL REFERRAL
IL367460OtherMEDICARE
MO508677101Medicaid
CI9392OtherMEDICARE RAILROAD
IL04232002OtherBCBS
MO114949OtherBCBS
MO24111584004OtherCIGNA PAL REFERRAL
MO=========OtherCIGNA HMO PPO OPEN ACCESS