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General NPI Number Information
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NPI Number | 1912913708
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Entity Type | Organization
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Legal Business Name | GATEWAY
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 1401 20TH ST S
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City | BIRMINGHAM
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State | AL
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Zip | 35205-4913
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Country | US
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Telephone | 205-510-2600
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Fax | 205-510-2621
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Provider Business Mailing Address
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Address Line | 1401 SOUTH 20TH STREET SOUTH
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City | BIRMINGHAM
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State | AL
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Zip | 35209
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Country | US
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Telephone | 205-510-2600
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Fax | 205-510-2621
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. E. JAMES LOOP
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Credential |
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Telephone | 205-510-2629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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