Provider Demographics
NPI:1649749052
Name:HANCOCK HEALTH GATEWAY SERVICES, INC.
Entity Type:Organization
Organization Name:HANCOCK HEALTH GATEWAY SERVICES, INC.
Other - Org Name:GATEWAY IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-468-4412
Mailing Address - Street 1:6189 W JOHN L. MODGLIN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-9364
Mailing Address - Country:US
Mailing Address - Phone:317-866-7300
Mailing Address - Fax:
Practice Address - Street 1:6189 JOHN L. MODGLIN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-9364
Practice Address - Country:US
Practice Address - Phone:317-866-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty