Provider Demographics
NPI:1720026446
Name:GATEWAY COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:GATEWAY COMMUNITY HEALTH CENTER, INC
Other - Org Name:GATEWAY COMMUNITY HEALTH CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-523-3642
Mailing Address - Street 1:2007 S ZAPATA HWY
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-6510
Mailing Address - Country:US
Mailing Address - Phone:956-523-3642
Mailing Address - Fax:956-795-8135
Practice Address - Street 1:2007 S ZAPATA HWY
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-6510
Practice Address - Country:US
Practice Address - Phone:956-523-3642
Practice Address - Fax:956-795-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451960Medicare PIN