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NPI Code Detail

MEDICARE: GATEWAY COMMUNITY HEALTH CENTER, INC. QUAD CITY

MEDICARE: GATEWAY COMMUNITY HEALTH CENTER, INC. QUAD CITY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1417971862
Entity Type Code : Organization
Provider Name (Legal Business Name) : GATEWAY COMMUNITY HEALTH CENTER, INC. QUAD CITY
Provider Business Mailing Address
First Line : 105 MAIN STREET
Second Line :
City : MIRANDO
State : TX
Zip : 78369
Country : US
Telephone Number : 512-586-4656
Fax Number :
Provider Business Practice Location Address
First Line : 2007 S ZAPATA HWY
Second Line :
City : LAREDO
State : TX
Zip : 78046-6510
Country : US
Telephone Number : 956-795-8101
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. MIGUEL TREVINO JR.
Credential :
Telephone Number : 956-795-8100
Provider Enumeration Date : 07/27/2006
Last Update Date : 02/11/2008

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