Provider Demographics
NPI:1477069375
Name:GAGE MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:GAGE MEDICAL CLINIC INC
Other - Org Name:MOTHER THERESA MEDICAL CENTER OF HUNTINGTON PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEECH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-699-2248
Mailing Address - Street 1:3203 E. FLORENCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-3908
Mailing Address - Country:US
Mailing Address - Phone:323-835-6310
Mailing Address - Fax:323-835-6382
Practice Address - Street 1:3203 E. FLORENCE AVE.
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-3008
Practice Address - Country:US
Practice Address - Phone:323-835-6310
Practice Address - Fax:323-835-6382
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAGE MEDICAL CLINIC INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-15
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29047208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty