Provider Demographics
NPI:1508519414
Name:GATEWAY HEALTHCARE
Entity Type:Organization
Organization Name:GATEWAY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-259-1000
Mailing Address - Street 1:1549 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-5685
Mailing Address - Country:US
Mailing Address - Phone:989-259-1000
Mailing Address - Fax:989-402-0097
Practice Address - Street 1:1549 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5685
Practice Address - Country:US
Practice Address - Phone:989-259-1000
Practice Address - Fax:989-402-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty