MEDICARE: GATEWAY IMAGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB0894	OTHER	IN	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1144217241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY IMAGING LLC

Provider Business Mailing Address
First Line	:	4087 GATEWAY BLVD
Second Line	:
City	:	NEWBURGH
State	:	IN
Zip	:	47630-8947
Country	:	US
Telephone Number	:	812-858-0080
Fax Number	:	812-858-6637

Provider Business Practice Location Address
First Line	:	4087 GATEWAY BLVD
Second Line	:
City	:	NEWBURGH
State	:	IN
Zip	:	47630-8947
Country	:	US
Telephone Number	:	812-858-0080
Fax Number	:	812-858-6637

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KATHLEEN B. DOCKERY
Credential	:
Telephone Number	:	812-422-3254

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	02/21/2008

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Directions to “GATEWAY IMAGING LLC ” Practice Location

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