Healthcare Provider Details

I. General information

NPI: 1538239835
Provider Name (Legal Business Name): GATEWAY COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 PAPPAS ST
LAREDO TX
78041-1705
US

IV. Provider business mailing address

1515 PAPPAS ST.
LAREDO TX
78041
US

V. Phone/Fax

Practice location:
  • Phone: 956-718-6259
  • Fax: 956-718-6294
Mailing address:
  • Phone: 956-718-6259
  • Fax: 956-718-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number13514
License Number StateTX

VIII. Authorized Official

Name: MR. MIGUEL TREVINO JR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 956-523-3646