Basic Information
| Provider Information | |||||||||
| NPI: | 1528008976 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MISSOURI EM-I MEDICAL SERVICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98806 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891938806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007321066 | ||||||||
| FaxNumber: | 6309681622 | ||||||||
| Practice Location | |||||||||
| Address1: | 3933 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631184601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148657000 | ||||||||
| FaxNumber: | 3148657073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | GATEWOOD | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8007321066 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.