MEDICARE: EMERGENCY DEPARTMENT ASSOCIATES, P.C.

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1659319754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGENCY DEPARTMENT ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 42911
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19101-2911
Country	:	US
Telephone Number	:	800-732-1066
Fax Number	:	630-941-4333

Provider Business Practice Location Address
First Line	:	8012 S CRANDON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-1124
Country	:	US
Telephone Number	:	773-356-5362
Fax Number	:	773-768-8154

Authorized Official
Title or Position	:	PRESIDENT/GENERAL PARTNER
Name	:	DR. JOSEPH H GATEWOOD
Credential	:	M.C.
Telephone Number	:	800-732-1066

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/24/2008

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