Provider Demographics
NPI:1710026125
Name:GATEWAY ANESTHESIA AND PAIN ASSOCIATES PLLC
Entity Type:Organization
Organization Name:GATEWAY ANESTHESIA AND PAIN ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:T
Authorized Official - Last Name:RANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-924-7091
Mailing Address - Street 1:4838 E BASELINE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4672
Mailing Address - Country:US
Mailing Address - Phone:480-981-2400
Mailing Address - Fax:480-981-2407
Practice Address - Street 1:4838 E BASELINE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4672
Practice Address - Country:US
Practice Address - Phone:480-981-2400
Practice Address - Fax:480-981-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207L00000X, 208VP0000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ190514Medicaid
AZZ114275Medicare PIN
AZ190514Medicaid