Healthcare Provider Details

I. General information

NPI: 1912420969
Provider Name (Legal Business Name): GATEWAY ENT & ALLERGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2017
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:
  • Fax: 304-250-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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