Healthcare Provider Details

I. General information

NPI: 1447070685
Provider Name (Legal Business Name): GATEWAY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 AGLER RD STE 1100
COLUMBUS OH
43219-3390
US

IV. Provider business mailing address

3433 AGLER RD STE 1100
COLUMBUS OH
43219-3390
US

V. Phone/Fax

Practice location:
  • Phone: 914-708-6574
  • Fax:
Mailing address:
  • Phone: 914-708-6574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES OKYERE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 914-708-6574