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General NPI Number Information
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NPI Number | 1790181873
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Entity Type | Organization
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Legal Business Name | GATEWAY MOBILE MEDICAL, LLC
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 208 N LANSDOWNE AVE
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City | LANSDOWNE
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State | PA
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Zip | 19050-1320
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Country | US
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Telephone | 267-975-9313
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Fax |
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Provider Business Mailing Address
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Address Line | 208 N LANSDOWNE AVE
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City | LANSDOWNE
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State | PA
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Zip | 19050-1320
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Country | US
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Telephone | 267-975-9313
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MS. BERNADINE O LEWIS
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Credential | PA-C
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Telephone | 267-975-9313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | MA050628
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License Number State | PA
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