Organization
GATEWAY PROFESSIONAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCE A FACTEAU (CREDENTIALING COORDINATOR)
(401) 724-8400
Entity
Organization
Contact information
Practice address
208 GOVERNOR ST, PROVIDENCE, RI 02906-3246
(401) 490-3563
(401) 490-3569
Mailing address
208 GOVERNOR ST, PROVIDENCE, RI 02906-3246
(401) 490-3563
(401) 490-3569
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
09/22/2006
Last updated
08/22/2020
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