Provider Demographics
NPI:1720192792
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:ELMO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-795-8100
Mailing Address - Street 1:1515 PAPPAS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1705
Mailing Address - Country:US
Mailing Address - Phone:956-795-8100
Mailing Address - Fax:956-795-8135
Practice Address - Street 1:1515 PAPPAS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-1705
Practice Address - Country:US
Practice Address - Phone:956-795-8100
Practice Address - Fax:956-795-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCN8581OtherPALMETTO
TX081896501Medicaid
TX092953101Medicaid
TX095019801OtherCSHCN
TX1013948447OtherNPI FOR MEDICARE NUMBER 45-1838
TX00CH47Medicare Oscar/Certification
TX451961Medicare PIN
TX451863Medicare PIN
TX092953101Medicaid
TX1013948447OtherNPI FOR MEDICARE NUMBER 45-1838
TX081896501Medicaid
TX095019801OtherCSHCN
TX451960Medicare PIN