1780281881 NPI number — GATEWAY PRESCRIPTION CENTER INC

Table of content: (NPI 1780281881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780281881 NPI number — GATEWAY PRESCRIPTION CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GATEWAY PRESCRIPTION CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BAYA MEDICAL
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780281881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
780 SE BAYA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32025-5403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
376-719-9952
Provider Business Mailing Address Fax Number:
386-438-5421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
742 SE BAYA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32025-6079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-755-2277
Provider Business Practice Location Address Fax Number:
386-466-1923
Provider Enumeration Date:
10/02/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALLISON
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
386-719-9952

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)