Provider Demographics
NPI:1346297413
Name:GATEWAY MEDCARE LLP
Entity Type:Organization
Organization Name:GATEWAY MEDCARE LLP
Other - Org Name:GATEWAY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AGBOLADE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ODUTAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-697-3100
Mailing Address - Street 1:300 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-2509
Mailing Address - Country:US
Mailing Address - Phone:254-697-3100
Mailing Address - Fax:254-697-3112
Practice Address - Street 1:300 W 4TH ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-2509
Practice Address - Country:US
Practice Address - Phone:254-697-3100
Practice Address - Fax:254-697-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH3186JMedicare UPIN