Provider Demographics
NPI:1770993370
Name:GATEWAY MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:GATEWAY MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:LOCKHART
Authorized Official - Last Name:REGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:530-515-4202
Mailing Address - Street 1:3082 MCMURRAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007
Mailing Address - Country:US
Mailing Address - Phone:530-365-1833
Mailing Address - Fax:530-365-5186
Practice Address - Street 1:9461 DESCHUTES RD
Practice Address - Street 2:UNIT 4
Practice Address - City:PALO CEDRO
Practice Address - State:CA
Practice Address - Zip Code:96073-9761
Practice Address - Country:US
Practice Address - Phone:530-365-1833
Practice Address - Fax:530-365-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology