Healthcare Provider Details

I. General information

NPI: 1457040479
Provider Name (Legal Business Name): GATEWAY ANESTHESIA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10296 BIG BEND RD
SAINT LOUIS MO
63122-6425
US

IV. Provider business mailing address

10431 FRONTENAC WOODS LN
SAINT LOUIS MO
63131-3422
US

V. Phone/Fax

Practice location:
  • Phone: 314-735-0200
  • Fax:
Mailing address:
  • Phone: 908-653-9399
  • Fax: 908-653-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: OLIVER WOLFE
Title or Position: OWNER
Credential: MD
Phone: 908-653-9399