| Gateway Geriatric Services Llc | |
|
12026 Conway Rd Saint Louis MO 63131-2417 | |
| (314) 225-6015 | |
| Not Available |
| Full Name | Gateway Geriatric Services Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12026 Conway Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Shailaja Pulisetty (PHYSICIAN/PRESIDENT) |
| Authorized Official Contact | 3142256015 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Geriatric Services Llc 12026 Conway Rd Saint Louis MO 63131-2417 Ph: (314) 225-6015 | Gateway Geriatric Services Llc 12026 Conway Rd Saint Louis MO 63131-2417 Ph: (314) 225-6015 |
| NPI Number | 1114219417 |
|---|---|
| Provider Enumeration Date | 05/05/2011 |
| Last Update Date | 07/13/2011 |
| Medicare PECOS PAC ID | 4183892425 |
|---|---|
| Medicare Enrollment ID | O20110712000731 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114219417 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | 2005019644 (Missouri) | Primary |
| Provider Name | Shailaja Pulisetty |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902014467 PECOS PAC ID: 2365458536 Enrollment ID: I20070619000255 |
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