Provider Demographics
NPI:1497437792
Name:GATEWAY SPINE AND PAIN PHYSICIANS, LLC
Entity Type:Organization
Organization Name:GATEWAY SPINE AND PAIN PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLEMBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-980-6500
Mailing Address - Street 1:329 REMINGTON BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5817
Mailing Address - Country:US
Mailing Address - Phone:630-226-1130
Mailing Address - Fax:
Practice Address - Street 1:12 SALT CREEK LN STE 350
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-8612
Practice Address - Country:US
Practice Address - Phone:630-226-1130
Practice Address - Fax:630-226-1134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY SPINE AND PAIN PHYSICIANS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty