MEDICARE: MARITIME ER SVCS PARTNERSHIP 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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	77076	OTHER	FL	BLUE SHIELD

General Provider Information

NPI Number	:	1750330874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARITIME ER SVCS PARTNERSHIP LLC

Provider Business Mailing Address
First Line	:	13737 NOEL RD
Second Line	:	STE 1600
City	:	DALLAS
State	:	TX
Zip	:	75240-1331
Country	:	US
Telephone Number	:	469-401-2386
Fax Number	:	214-712-2444

Provider Business Practice Location Address
First Line	:	6500 38TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1629
Country	:	US
Telephone Number	:	727-341-4870
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH H. GATEWOOD
Credential	:	M.D.
Telephone Number	:	469-401-2386

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	06/20/2014

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