Provider Demographics
NPI:1043551062
Name:GATEWAY HEARING SERVICES, INC
Entity Type:Organization
Organization Name:GATEWAY HEARING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:HOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-724-0501
Mailing Address - Street 1:3351 M ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2700
Mailing Address - Country:US
Mailing Address - Phone:209-724-0501
Mailing Address - Fax:209-724-0602
Practice Address - Street 1:3351 M ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2700
Practice Address - Country:US
Practice Address - Phone:209-724-0501
Practice Address - Fax:209-724-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7006332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
C51972Medicare UPIN