MEDICARE: GATEWAY MEDICAL LLC

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
1	363LG0600X	Gerontology Nurse Practitioner
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649647884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY MEDICAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 2169
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29071-2169
Country	:	US
Telephone Number	:	803-358-6762
Fax Number	:	803-358-1708

Provider Business Practice Location Address
First Line	:	171B MONROE LN
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-3904
Country	:	US
Telephone Number	:	803-358-8496
Fax Number	:	866-614-3887

Authorized Official
Title or Position	:	COO/EXEC VP
Name	:	CHRISTINA M JEFFCOAT
Credential	:
Telephone Number	:	803-957-0500

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	07/24/2025

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Directions to “GATEWAY MEDICAL LLC ” Practice Location

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