Provider Demographics
NPI:1184643256
Name:GATEWAY COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:GATEWAY COMMUNITY HEALTH CENTER, INC.
Other - Org Name:GATEWAY COMMUNITY HEALTH CENTER, INC. QUAD CITY COMMUNITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-523-3646
Mailing Address - Street 1:917 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MIRANDO
Mailing Address - State:TX
Mailing Address - Zip Code:78369-0220
Mailing Address - Country:US
Mailing Address - Phone:956-523-3642
Mailing Address - Fax:956-795-8135
Practice Address - Street 1:1515 PAPPAS ST
Practice Address - Street 2:1515 PAPPAS ST
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-1705
Practice Address - Country:US
Practice Address - Phone:956-523-3642
Practice Address - Fax:956-718-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1013948447OtherNPI FOR MEDICARE NUMBER 451961
TX1922020015Medicaid
TX092953101Medicaid
TX092953101Medicaid