Provider Demographics
NPI:1639573884
Name:GATEWAY HEALTH PLAN OF OHIO, INC
Entity Type:Organization
Organization Name:GATEWAY HEALTH PLAN OF OHIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BUSINESS DEVELOPMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IFEDIRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-255-4654
Mailing Address - Street 1:444 LIBERTY AVE
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1220
Mailing Address - Country:US
Mailing Address - Phone:412-255-4640
Mailing Address - Fax:
Practice Address - Street 1:444 LIBERTY AVE
Practice Address - Street 2:SUITE 2100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1220
Practice Address - Country:US
Practice Address - Phone:412-255-4640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization