Healthcare Provider Details

I. General information

NPI: 1184643256
Provider Name (Legal Business Name): GATEWAY COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 PAPPAS ST 1515 PAPPAS ST
LAREDO TX
78041-1705
US

IV. Provider business mailing address

917 N MAIN STREET
MIRANDO TX
78369-0220
US

V. Phone/Fax

Practice location:
  • Phone: 956-523-3642
  • Fax: 956-718-6294
Mailing address:
  • Phone: 956-523-3642
  • Fax: 956-795-8135

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: 956-523-3646