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General NPI Number Information
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NPI Number | 1124325865
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Entity Type | Organization
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Legal Business Name | GATEWAY URGENT CARE, LLC
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 3245 MOUNT MORIAH AVE SUITE 10
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City | OWENSBORO
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State | KY
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Zip | 42303-7834
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Country | US
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Telephone | 270-570-7500
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Fax | 270-689-0051
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Provider Business Mailing Address
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Address Line | 3245 MOUNT MORIAH AVE SUITE 10
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City | OWENSBORO
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State | KY
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Zip | 42303-7834
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Country | US
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Telephone | 270-663-0955
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Fax | 270-663-0957
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Authorized Official
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Title or Position | PART OWNER
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Name | MR. JOHN MCNULTY
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Credential |
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Telephone | 270-570-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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