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General NPI Number Information
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NPI Number | 1952372096
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Entity Type | Organization
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Legal Business Name | GATEWAY SPINE, LLC
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 3009 N BALLAS RD SUITE 131 A
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2322
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Country | US
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Telephone | 314-993-6170
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Fax | 314-993-6169
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Provider Business Mailing Address
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Address Line | PO BOX 31698
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City | SAINT LOUIS
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State | MO
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Zip | 63131-0698
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Country | US
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Telephone | 314-989-0300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TOM REINSEL
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Credential | MD
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Telephone | 314-909-9669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2003007554
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License Number State | MO
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