Healthcare Provider Details

I. General information

NPI: 1457088858
Provider Name (Legal Business Name): GATE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 E MAIN ST STE 202-A
EL CAJON CA
92021-5225
US

IV. Provider business mailing address

960 E CHASE AVE APT G
EL CAJON CA
92020-7666
US

V. Phone/Fax

Practice location:
  • Phone: 858-844-8730
  • Fax:
Mailing address:
  • Phone: 619-737-6219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. GLENN ALLEN THORNTON JR.
Title or Position: PRESIDENT
Credential: RCP
Phone: 619-737-6219