Provider Demographics
NPI: | 1518231554 |
---|---|
Name: | GATEWAY ANESTHESIA LLC |
Entity Type: | Organization |
Organization Name: | GATEWAY ANESTHESIA LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | BUSINESS MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | T |
Authorized Official - Last Name: | MITCHELL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 843-651-2624 |
Mailing Address - Street 1: | PO BOX 4860 |
Mailing Address - Street 2: | |
Mailing Address - City: | MURRELLS INLET |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29576-2698 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 843-651-2624 |
Mailing Address - Fax: | 843-357-4940 |
Practice Address - Street 1: | 1007 HARLOW RD |
Practice Address - Street 2: | SUITE 110 |
Practice Address - City: | SPRINGFIELD |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97477-7124 |
Practice Address - Country: | US |
Practice Address - Phone: | 541-726-8882 |
Practice Address - Fax: | 541-726-8844 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-03-07 |
Last Update Date: | 2012-03-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Single Specialty |