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General NPI Number Information
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NPI Number | 1831437540
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Entity Type | Organization
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Legal Business Name | GATEWAY MEDICAL DIRECT LLC
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 12094 COUNTRY DAY CIR
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City | FORT MYERS
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State | FL
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Zip | 33913-7620
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Country | US
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Telephone | 816-217-3355
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Fax |
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Provider Business Mailing Address
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Address Line | 12094 COUNTRY DAY CIR
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City | FORT MYERS
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State | FL
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Zip | 33913-7620
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Country | US
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Telephone | 816-217-3355
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DENISE SCHOONOVER
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Credential |
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Telephone | 816-217-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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