Provider Demographics
NPI:1689962078
Name:GATEWAY VASCULAR ACCESS, LLC
Entity type:Organization
Organization Name:GATEWAY VASCULAR ACCESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEES
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGING MEMBER
Authorized Official - Phone:727-474-0090
Mailing Address - Street 1:3001 PALM HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1930
Mailing Address - Country:US
Mailing Address - Phone:727-474-0090
Mailing Address - Fax:
Practice Address - Street 1:13303 TESSON FERRY RD
Practice Address - Street 2:SUITE 125
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-4062
Practice Address - Country:US
Practice Address - Phone:314-541-3177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center