Provider Demographics
NPI:1538127410
Name:GATEWAY SURGERY CENTER
Entity Type:Organization
Organization Name:GATEWAY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-243-2511
Mailing Address - Street 1:841 SPRINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-3579
Mailing Address - Country:US
Mailing Address - Phone:563-244-9955
Mailing Address - Fax:563-243-3461
Practice Address - Street 1:841 SPRINGDALE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-3579
Practice Address - Country:US
Practice Address - Phone:563-244-9955
Practice Address - Fax:563-243-3461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-02
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5253930001Medicare NSC