Healthcare Provider Details

I. General information

NPI: 1063589000
Provider Name (Legal Business Name): GATEWAY HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 E 82ND ST STE C
INDIANAPOLIS IN
46256-1458
US

IV. Provider business mailing address

7320 E 82ND ST STE C
INDIANAPOLIS IN
46256-1458
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-5771
  • Fax: 317-842-5953
Mailing address:
  • Phone: 317-842-5771
  • Fax: 317-842-5953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number60005436A
License Number StateIN

VIII. Authorized Official

Name: KURT MOYER
Title or Position: DIRECTOR OF CLINICAL PHARMACY
Credential:
Phone: 317-842-5771