=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871804815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GATEWAY SURGERY CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2010
-----------------------------------------------------
Last Update Date | 09/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 494 NORTHAMPTON ST SUITE 2
-----------------------------------------------------
City | EDWARDSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18704-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-718-6692
-----------------------------------------------------
Fax | 570-718-6696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 494 NORTHAMPTON ST STE 2
-----------------------------------------------------
City | EDWARDSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18704-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER/AO
-----------------------------------------------------
Name | MR. JONATHAN BAILEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-609-1168
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------