Healthcare Provider Details

I. General information

NPI: 1295262376
Provider Name (Legal Business Name): GATEWAY ENT & ALLERGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 GEORGE ST
BECKLEY WV
25801-2641
US

IV. Provider business mailing address

PO BOX 564
MABSCOTT WV
25871-0564
US

V. Phone/Fax

Practice location:
  • Phone: 304-254-8272
  • Fax: 304-254-8280
Mailing address:
  • Phone: 304-520-6725
  • Fax: 304-250-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BILLIE JEAN CRIGGER
Title or Position: OWNER
Credential: DO
Phone: 304-254-8272