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General NPI Number Information
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NPI Number | 1457974156
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Entity Type | Organization
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Legal Business Name | GATEWAY MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 08/16/2020
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Provider Practice Location Address
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Address Line | 1108 NEW YORK AVE UNIT 1
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City | SAINT CLOUD
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State | FL
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Zip | 34769-3701
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Country | US
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Telephone | 407-337-5112
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Fax | 407-337-5113
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Provider Business Mailing Address
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Address Line | 5351 COSTA DEL SOL DR
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City | SAINT CLOUD
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State | FL
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Zip | 34771-7561
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Country | US
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Telephone | 954-415-5931
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | UCHE UKEAGU
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Credential | DC
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Telephone | 954-415-5931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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