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Organization

GRANITE CITY EMERGENCY PHYSICIANS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOSEPH H GATEWOOD M.D. (PRESIDENT)
(469) 401-2386
Entity
Organization

Contact information

Practice address
2100 MADISON AVE, GRANITE CITY, IL 62040-4701
(618) 798-3000
(618) 798-3260
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(469) 401-2386
(214) 712-2444

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
183631
BLUE SHIELD
MO
05
501288609
MO
01
6032077
BLUE SHIELD
IL
Enumeration date
06/06/2006
Last updated
02/05/2014
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