Provider Demographics
NPI:1538239835
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 1:1515 PAPPAS ST.
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-718-6259
Mailing Address - Fax:956-718-6294
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:956-718-6259
Practice Address - Fax:956-718-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0074738OtherDPS NUMBER
TXBL2217429OtherDRUG ENFORCEMENT AGENCY
TX13514OtherSTATE BD OF PHARMACY