Healthcare Provider Details

I. General information

NPI: 1699108282
Provider Name (Legal Business Name): GATEWAY EMERGENCY PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W HICKORY ST
NEOSHO MO
64850-1705
US

IV. Provider business mailing address

75 REMIT DR SUITE 1367
CHICAGO IL
60675-1367
US

V. Phone/Fax

Practice location:
  • Phone: 417-451-1234
  • Fax: 417-455-4355
Mailing address:
  • Phone: 866-916-5259
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DERIK K KING
Title or Position: LLP MANAGING PARTNER
Credential: MD
Phone: 866-916-5259