Healthcare Provider Details

I. General information

NPI: 1891067807
Provider Name (Legal Business Name): OLMOS BASIN INPATIENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 TREELINE PARK
SAN ANTONIO TX
78209-2042
US

IV. Provider business mailing address

P.O. BOX 98706
LAS VEGAS NV
89193-8706
US

V. Phone/Fax

Practice location:
  • Phone: 727-507-2513
  • Fax:
Mailing address:
  • Phone: 727-507-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH H GATEWOOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 727-507-2513