Provider Demographics
NPI:1144217241
Name:GATEWAY IMAGING LLC
Entity Type:Organization
Organization Name:GATEWAY IMAGING LLC
Other - Org Name:MIDWEST RADIOLOGIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOCKERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-422-3254
Mailing Address - Street 1:4087 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8947
Mailing Address - Country:US
Mailing Address - Phone:812-858-0080
Mailing Address - Fax:812-858-6637
Practice Address - Street 1:4087 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8947
Practice Address - Country:US
Practice Address - Phone:812-858-0080
Practice Address - Fax:812-858-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDB0894OtherRAILROAD MEDICARE
INDB0894OtherRAILROAD MEDICARE