Healthcare Provider Details

I. General information

NPI: 1629258777
Provider Name (Legal Business Name): SPACE CITY EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N TEXAS AVE
WEBSTER TX
77598-4966
US

IV. Provider business mailing address

815 S PALAFOX ST 3 FLOOR
PENSACOLA FL
32502-5960
US

V. Phone/Fax

Practice location:
  • Phone: 281-335-1700
  • Fax: 281-335-1708
Mailing address:
  • Phone: 800-444-7009
  • Fax: 800-305-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH H GATEWOOD
Title or Position: PRESIDENT
Credential: MD
Phone: 800-362-2731