Healthcare Provider Details

I. General information

NPI: 1518891365
Provider Name (Legal Business Name): GATEWAY ANESTHESIA PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 OLIVE BLVD STE 200
SAINT LOUIS MO
63141-5436
US

IV. Provider business mailing address

12400 OLIVE BLVD STE 200
SAINT LOUIS MO
63141-5436
US

V. Phone/Fax

Practice location:
  • Phone: 618-391-1660
  • Fax: 618-861-6003
Mailing address:
  • Phone: 618-391-1660
  • Fax: 618-861-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL V STOCK
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 618-391-1660