Provider Demographics
NPI:1770035214
Name:GATEWAY HEALTHCARE, PC
Entity Type:Organization
Organization Name:GATEWAY HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:WEATHERSBY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:615-225-2070
Mailing Address - Street 1:1574 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3760
Mailing Address - Country:US
Mailing Address - Phone:615-225-2070
Mailing Address - Fax:
Practice Address - Street 1:1574 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3760
Practice Address - Country:US
Practice Address - Phone:615-225-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1879261QU0200X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1013OtherSTATE OF TENNESSEE DEPT OF HEALTH