Provider Demographics
NPI:1871109553
Name:GATEWAY ANESTHESIA PLLC
Entity type:Organization
Organization Name:GATEWAY ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:VUDHI
Authorized Official - Middle Name:V
Authorized Official - Last Name:SLABISAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-390-7697
Mailing Address - Street 1:960 RIDGEVIEW DRIVE
Mailing Address - Street 2:STE 140 PMB 198
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:416 WOODLAKE DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3436
Practice Address - Country:US
Practice Address - Phone:214-390-7697
Practice Address - Fax:888-770-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty