| Gateway Medical Llc | |
|
171b Monroe Ln Lexington SC 29072-3904 | |
| (803) 358-8496 | |
| (866) 614-3887 |
| Full Name | Gateway Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 171b Monroe Ln, Lexington, South Carolina |
| Authorized Official Name and Position | Christina M Jeffcoat (VICE PRESIDENT & SECRETARY) |
| Authorized Official Contact | 8039570500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Medical Llc Po Box 2169 Lexington SC 29071-2169 Ph: (803) 358-6762 | Gateway Medical Llc 171b Monroe Ln Lexington SC 29072-3904 Ph: (803) 358-8496 |
| NPI Number | 1649647884 |
|---|---|
| Provider Enumeration Date | 08/24/2015 |
| Last Update Date | 03/15/2021 |
| Medicare PECOS PAC ID | 5496056814 |
|---|---|
| Medicare Enrollment ID | O20151209000470 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649647884 | NPI | - | NPPES |
| GP7520 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LG0600X | Nurse Practitioner - Gerontology | (* (Not Available)) | Secondary |
| Provider Name | John Paul Short |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1235176520 PECOS PAC ID: 6002891124 Enrollment ID: I20131112001462 |
| Provider Name | Angela A Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053834705 PECOS PAC ID: 2365708302 Enrollment ID: I20171108001716 |
| Provider Name | Elizabeth Ann Hinz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699181230 PECOS PAC ID: 2860750304 Enrollment ID: I20171211002089 |
| Provider Name | Tara P Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649460080 PECOS PAC ID: 3678601317 Enrollment ID: I20240305003280 |
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