Healthcare Provider Details

I. General information

NPI: 1811368244
Provider Name (Legal Business Name): GATEWAY MIDWEST HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12174 NATURAL BRIDGE RD
BRIDGETON MO
63044-2017
US

IV. Provider business mailing address

12174 NATURAL BRIDGE RD
BRIDGETON MO
63044-2017
US

V. Phone/Fax

Practice location:
  • Phone: 314-481-5000
  • Fax: 314-481-3037
Mailing address:
  • Phone: 314-481-5000
  • Fax: 314-481-3037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRENCE ERIC CHAVIS
Title or Position: OWNER
Credential:
Phone: 314-551-0338