Healthcare Provider Details

I. General information

NPI: 1154590610
Provider Name (Legal Business Name): GATEWAY COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 S ZAPATA HWY
LAREDO TX
78046-6510
US

IV. Provider business mailing address

2007 S ZAPATA HWY
LAREDO TX
78046-6510
US

V. Phone/Fax

Practice location:
  • Phone: 956-523-3642
  • Fax: 956-718-6294
Mailing address:
  • Phone: 956-523-3642
  • Fax: 956-718-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. MIGUEL TREVINO JR.
Title or Position: CEO
Credential:
Phone: 956-523-3642