Provider Demographics
NPI:1063589000
Name:GATEWAY HEALTH SERVICES LLC
Entity type:Organization
Organization Name:GATEWAY HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-842-5771
Mailing Address - Street 1:7320 E 82ND ST
Mailing Address - Street 2:STE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1458
Mailing Address - Country:US
Mailing Address - Phone:317-842-5771
Mailing Address - Fax:317-842-5953
Practice Address - Street 1:7320 E 82ND ST STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1458
Practice Address - Country:US
Practice Address - Phone:317-842-5771
Practice Address - Fax:317-842-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IN60005436A3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1564308OtherNCPDP PROVIDER IDENTIFICATION NUMBER