Provider Demographics
NPI:1861408650
Name:GATEWAY HEALTHCARE LTD
Entity type:Organization
Organization Name:GATEWAY HEALTHCARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MAHRUKH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-961-3038
Mailing Address - Street 1:PO BOX 2153 DEPT 30704
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-9257
Mailing Address - Country:US
Mailing Address - Phone:314-961-3038
Mailing Address - Fax:
Practice Address - Street 1:7491 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2101
Practice Address - Country:US
Practice Address - Phone:314-961-3038
Practice Address - Fax:314-961-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103822261QH0100X
261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH41009Medicare UPIN