Provider Demographics
NPI:1700066370
Name:GATEWAY HEALTH CARE INC
Entity type:Organization
Organization Name:GATEWAY HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-567-0560
Mailing Address - Street 1:7428 ETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1608
Mailing Address - Country:US
Mailing Address - Phone:314-567-0560
Mailing Address - Fax:314-989-1336
Practice Address - Street 1:7428 ETHEL AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1608
Practice Address - Country:US
Practice Address - Phone:314-567-0560
Practice Address - Fax:314-989-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR 38192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21842OtherBLUE CROSS BLUE SHIELD