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General NPI Number Information
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NPI Number | 1891067807
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Entity Type | Organization
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Legal Business Name | OLMOS BASIN INPATIENT SERVICES
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 403 TREELINE PARK
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City | SAN ANTONIO
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State | TX
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Zip | 78209-2042
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Country | US
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Telephone | 727-507-2513
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 98706
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City | LAS VEGAS
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State | NV
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Zip | 89193-8706
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Country | US
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Telephone | 727-507-2513
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH H GATEWOOD
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Credential | M.D.
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Telephone | 727-507-2513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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