Healthcare Provider Details

I. General information

NPI: 1245518604
Provider Name (Legal Business Name): MISSOURI EM-I MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 E 39TH ST S
INDEPENDENCE MO
64057-2301
US

IV. Provider business mailing address

PO BOX 98544
LAS VEGAS NV
89193
US

V. Phone/Fax

Practice location:
  • Phone: 800-355-0808
  • Fax: 610-834-2862
Mailing address:
  • Phone: 800-355-0808
  • Fax: 610-834-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH H GATEWOOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-712-2000