Basic Information
| Provider Information | |||||||||
| NPI: | 1215330014 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE GATEWAY CENTER LAS VEGAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74 NORTH PECOS | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890747344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027784500 | ||||||||
| FaxNumber: | 7027783500 | ||||||||
| Practice Location | |||||||||
| Address1: | 74 NORTH PECOS | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890747344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027784500 | ||||||||
| FaxNumber: | 7027783500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | STILL | ||||||||
| AuthorizedOfficialFirstName: | MEREDITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/HR | ||||||||
| AuthorizedOfficialTelephone: | 7027784500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OWNER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | NV | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.