| Gateway Psychiatric Group, Llc | |
|
11710 Old Ballas Rd Suite 110 Creve Coeur MO 63141-7076 | |
| (314) 567-1958 | |
| (314) 567-0037 |
| Full Name | Gateway Psychiatric Group, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 11710 Old Ballas Rd, Creve Coeur, Missouri |
| Authorized Official Name and Position | Gordon Robinson (OWNER) |
| Authorized Official Contact | 3145671958 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Psychiatric Group, Llc 11710 Old Ballas Rd Suite 110 Creve Coeur MO 63141-7076 Ph: (314) 567-1958 | Gateway Psychiatric Group, Llc 11710 Old Ballas Rd Suite 110 Creve Coeur MO 63141-7076 Ph: (314) 567-1958 |
| NPI Number | 1902244825 |
|---|---|
| Provider Enumeration Date | 06/13/2013 |
| Last Update Date | 06/13/2013 |
| Medicare PECOS PAC ID | 5991944829 |
|---|---|
| Medicare Enrollment ID | O20201117003192 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902244825 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | 100250 (Missouri) | Primary |
| Provider Name | Gordon H Robinson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245342161 PECOS PAC ID: 0547307183 Enrollment ID: I20201117003307 |
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