Provider Demographics
NPI:1770102907
Name:GATEWAY CARDIOVASCULAR LLC
Entity type:Organization
Organization Name:GATEWAY CARDIOVASCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WJ
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-701-4213
Mailing Address - Street 1:507 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1439
Mailing Address - Country:US
Mailing Address - Phone:573-631-0994
Mailing Address - Fax:
Practice Address - Street 1:507 W PINE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1439
Practice Address - Country:US
Practice Address - Phone:573-631-0994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty