Healthcare Provider Details

I. General information

NPI: 1265744387
Provider Name (Legal Business Name): MOUND CITY INPATIENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 DOUGHERTY FERRY ROAD
ST. LOUIS MO
63122
US

IV. Provider business mailing address

1717 MAIN STREET SUITE 5200
DALLAS TX
75201-7365
US

V. Phone/Fax

Practice location:
  • Phone: 314-966-9100
  • Fax:
Mailing address:
  • Phone: 214-712-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH H. GATEWOOD
Title or Position: PRESIDENT / OWNER
Credential: M.D.
Phone: 214-712-2472