Provider Demographics
NPI:1184700205
Name:GATEWAY COMMUNITY HEALTH CENTER, INC.
Entity type:Organization
Organization Name:GATEWAY COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
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:956-523-3646
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:956-718-6259
Mailing Address - Fax:
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:956-718-6259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21321OtherTEXAS PHARMACY LICENSE
TX4520816OtherNCPDP NUMBER
TXBG7629883OtherDEA NUMBER