Provider Demographics
NPI:1699409581
Name:GATEWAY TRANSPORTATION LLC
Entity Type:Organization
Organization Name:GATEWAY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:J
Authorized Official - Last Name:WUSTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-509-1541
Mailing Address - Street 1:4600 N M 37 HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-8806
Mailing Address - Country:US
Mailing Address - Phone:269-205-2618
Mailing Address - Fax:
Practice Address - Street 1:4600 N M 37 HWY STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-8806
Practice Address - Country:US
Practice Address - Phone:269-205-2618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)