| Gateway Digestive And Liver Specialists, Llc | |
|
4510 Delmar Blvd Saint Louis MO 63108-1702 | |
| (314) 454-6903 | |
| (314) 454-6652 |
| Full Name | Gateway Digestive And Liver Specialists, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4510 Delmar Blvd, Saint Louis, Missouri |
| Authorized Official Name and Position | Rachel A Montemayor (OFFICE MANAGER) |
| Authorized Official Contact | 3144546903 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Digestive And Liver Specialists, Llc 4510 Delmar Blvd Saint Louis MO 63108-1702 Ph: (314) 454-6903 | Gateway Digestive And Liver Specialists, Llc 4510 Delmar Blvd Saint Louis MO 63108-1702 Ph: (314) 454-6903 |
| NPI Number | 1265566780 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 07/08/2016 |
| Medicare PECOS PAC ID | 6103800552 |
|---|---|
| Medicare Enrollment ID | O20040715000327 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265566780 | NPI | - | NPPES |
| 208107912 | Medicaid | MO | |
| DC2409 | Other | MO | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 107492 (Missouri) | Primary |
| Provider Name | Damon Cory Clines |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508800582 PECOS PAC ID: 9739163197 Enrollment ID: I20040721000314 |
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