Organization
GATEWAY MONITORING SPECIALITIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRASE MAHAN (MANAGER)
(214) 675-0905
Entity
Organization
Contact information
Practice address
9521 RIVERSIDE PKWY, #338, TULSA, OK 74137-7418
(918) 895-7680
Mailing address
PO BOX 268977, OKLAHOMA CITY, OK 73126-8977
(918) 895-7680
(214) 317-4888
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LC0014886887
LICENSE
MO
Enumeration date
06/07/2016
Last updated
06/07/2016
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