Basic Information
| Provider Information | |||||||||
| NPI: | 1174929947 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKHILL MEDICAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 ENCHANTED WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760510965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174211066 | ||||||||
| FaxNumber: | 8178863657 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 ENCHANTED WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760510965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174211066 | ||||||||
| FaxNumber: | 8178863657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2014 | ||||||||
| LastUpdateDate: | 11/06/2014 | ||||||||
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| AuthorizedOfficialLastName: | WYANT | ||||||||
| AuthorizedOfficialFirstName: | GLEN | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8174211066 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP3000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 207Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.