Provider Demographics
NPI:1699774893
Name:GATES HOSPITALISTS LLC
Entity type:Organization
Organization Name:GATES HOSPITALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-968-9320
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64069-0256
Mailing Address - Country:US
Mailing Address - Phone:816-968-9320
Mailing Address - Fax:
Practice Address - Street 1:2750 CLAY EDWARDS DR STE 200A
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-968-9320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000174342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO509340907Medicaid
KS200305270AMedicaid
MO33624016OtherBLUE SHIELD KANSAS CITY
MODB5075Medicare PIN
MO33624016OtherBLUE SHIELD KANSAS CITY