Healthcare Provider Details

I. General information

NPI: 1972793610
Provider Name (Legal Business Name): GATEWAY SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 THE LEGENDS PKWY
EUREKA MO
63025-3821
US

IV. Provider business mailing address

PO BOX 31698
SAINT LOUIS MO
63131-0698
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-1600
  • Fax: 636-938-1610
Mailing address:
  • Phone: 314-989-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TOM REINSEL
Title or Position: OWNER
Credential: MD
Phone: 314-993-6170