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General NPI Number Information
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NPI Number | 1790772259
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Entity Type | Organization
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Legal Business Name | GATEWAY FAMILY HEALTH CLINIC, LTD.
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 707 LUNDORFF DR STE 1
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City | SANDSTONE
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State | MN
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Zip | 55072-5099
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Country | US
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Telephone | 320-245-2250
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Fax | 320-245-2555
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Provider Business Mailing Address
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Address Line | 4570 CTY HWY 61
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City | MOOSE LAKE
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State | MN
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Zip | 55767-9401
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Country | US
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Telephone | 218-485-4491
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Fax | 218-485-4724
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ERIC P. NIELSEN
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Credential |
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Telephone | 218-485-4491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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