Provider Demographics
NPI:1134288814
Name:GATEWAY COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:GATEWAY COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-718-6259
Mailing Address - Street 1:PO BOX 3397
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78044-3397
Mailing Address - Country:US
Mailing Address - Phone:956-718-6259
Mailing Address - Fax:956-718-6294
Practice Address - Street 1:473 STATE HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:HEBBRONVILLE
Practice Address - State:TX
Practice Address - Zip Code:78361-4430
Practice Address - Country:US
Practice Address - Phone:361-527-4053
Practice Address - Fax:956-718-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081896501Medicaid
TX092953101Medicaid
TX1013948447OtherNPI FOR MEDICARE NUMBER 671917
TX1134288814OtherNPI FOR 671917
TX00CH47Medicare UPIN
TX671917Medicare Oscar/Certification
TX092953101Medicaid