Provider Demographics
NPI:1649390501
Name:GATEWAY CAPITAL CORPORATION
Entity Type:Organization
Organization Name:GATEWAY CAPITAL CORPORATION
Other - Org Name:RICH'S ORTHOPEDIC & REGULAR SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYNN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOUIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:619-523-6222
Mailing Address - Street 1:7763 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1701
Mailing Address - Country:US
Mailing Address - Phone:619-523-6222
Mailing Address - Fax:619-523-0311
Practice Address - Street 1:7763 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1701
Practice Address - Country:US
Practice Address - Phone:619-464-8391
Practice Address - Fax:619-523-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1128880001Medicare NSC