Provider Demographics
NPI:1134696099
Name:HANCOCK HEALTH GATEWAY SERVICES, INC.
Entity Type:Organization
Organization Name:HANCOCK HEALTH GATEWAY SERVICES, INC.
Other - Org Name:GATEWAY IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-468-4412
Mailing Address - Street 1:6189 W. JOHN L. MODGLIN DR.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-9364
Mailing Address - Country:US
Mailing Address - Phone:317-866-7301
Mailing Address - Fax:317-866-7101
Practice Address - Street 1:6189 W. JOHN L. MODGLIN DR.
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-9364
Practice Address - Country:US
Practice Address - Phone:317-866-7301
Practice Address - Fax:317-866-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory