Provider Demographics
NPI:1376710848
Name:GATEWAY INTERVENTIONAL SURGERY CENTER
Entity Type:Organization
Organization Name:GATEWAY INTERVENTIONAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-226-1322
Mailing Address - Street 1:215 REMINGTON BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3656
Mailing Address - Country:US
Mailing Address - Phone:630-226-1322
Mailing Address - Fax:630-226-1134
Practice Address - Street 1:215 REMINGTON BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3656
Practice Address - Country:US
Practice Address - Phone:630-226-1322
Practice Address - Fax:630-226-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain