Provider Demographics
NPI:1760448716
Name:GATEWAY AREA MEDICAL SPEC
Entity type:Organization
Organization Name:GATEWAY AREA MEDICAL SPEC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-371-1771
Mailing Address - Street 1:635C MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2377
Mailing Address - Country:US
Mailing Address - Phone:814-371-1771
Mailing Address - Fax:814-371-4417
Practice Address - Street 1:635C MAPLE AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2377
Practice Address - Country:US
Practice Address - Phone:814-371-1771
Practice Address - Fax:814-371-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010511850004Medicaid