| Gateway Regenerative Medicine, Llc | |
|
456 N New Ballas Rd Ste 101 Saint Louis MO 63141-6850 | |
| (314) 384-3600 | |
| Not Available |
| Full Name | Gateway Regenerative Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 456 N New Ballas Rd Ste 101, Saint Louis, Missouri |
| Authorized Official Name and Position | Robert Crittenden (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3143843600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Regenerative Medicine, Llc 456 N New Ballas Rd Ste 101 Saint Louis MO 63141-6850 Ph: (314) 520-9315 | Gateway Regenerative Medicine, Llc 456 N New Ballas Rd Ste 101 Saint Louis MO 63141-6850 Ph: (314) 384-3600 |
| NPI Number | 1225741143 |
|---|---|
| Provider Enumeration Date | 01/05/2023 |
| Last Update Date | 05/04/2023 |
| Medicare PECOS PAC ID | 0941671945 |
|---|---|
| Medicare Enrollment ID | O20230131001434 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225741143 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Devin C Bell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710240221 PECOS PAC ID: 8527213768 Enrollment ID: I20150831003103 |
| Provider Name | Laura Ann Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093250334 PECOS PAC ID: 7416202197 Enrollment ID: I20180620003197 |
| Provider Name | Jeffrey Wilcox |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1164791703 PECOS PAC ID: 1052717105 Enrollment ID: I20210915001007 |
| Provider Name | Kathleen Delain Decker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780168823 PECOS PAC ID: 9931507175 Enrollment ID: I20211001001982 |
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