Basic Information
| Provider Information | |||||||||
| NPI: | 1770993370 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GATEWAY MEDICAL SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3082 MCMURRAY DRIVE | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303651833 | ||||||||
| FaxNumber: | 5303655186 | ||||||||
| Practice Location | |||||||||
| Address1: | 9461 DESCHUTES RD | ||||||||
| Address2: | UNIT 4 | ||||||||
| City: | PALO CEDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960739761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303651833 | ||||||||
| FaxNumber: | 5303655186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2014 | ||||||||
| LastUpdateDate: | 08/11/2015 | ||||||||
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| AuthorizedOfficialLastName: | REGUERA | ||||||||
| AuthorizedOfficialFirstName: | TIFFANY | ||||||||
| AuthorizedOfficialMiddleName: | LOCKHART | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5305154202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 246XS1301X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Cardiovascular | Sonography | 2471C3402X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography | 2471S1302X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Sonography | 2471V0105X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Vascular Sonography | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.