Healthcare Provider Details

I. General information

NPI: 1740908003
Provider Name (Legal Business Name): GATEWAY AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1987 HIGHWAY A STE 210
WASHINGTON MO
63090-7133
US

IV. Provider business mailing address

9701 LANDMARK PARKWAY DR STE 201
SAINT LOUIS MO
63127-1665
US

V. Phone/Fax

Practice location:
  • Phone: 866-775-6736
  • Fax:
Mailing address:
  • Phone: 314-843-3828
  • Fax: 314-843-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN WEST
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 314-843-3828