Provider Demographics
NPI:1710027701
Name:GATEWAY REGIONAL HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:GATEWAY REGIONAL HEALTH SYSTEMS INC
Other - Org Name:BATH FAMILY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BORROWDALE-COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-674-9776
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:44 WATER ST
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360
Mailing Address - Country:US
Mailing Address - Phone:606-674-9776
Mailing Address - Fax:606-674-9708
Practice Address - Street 1:44 WATER ST
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360
Practice Address - Country:US
Practice Address - Phone:606-674-9776
Practice Address - Fax:606-674-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000805Medicaid
KY78009875Medicaid
KY64346372Medicaid
KYP79131Medicare UPIN
KY31000805Medicaid
KY0623003Medicare ID - Type UnspecifiedBORROWDALE-COX MEDICARE
KY78009875Medicaid