Basic Information
| Provider Information | |||||||||
| NPI: | 1811138431 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKWAY MEDICAL CLINIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1874 BELTLINE RD SW | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356015514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563502211 | ||||||||
| FaxNumber: | 2563013384 | ||||||||
| Practice Location | |||||||||
| Address1: | 1874 BELTLINE RD SW | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356015514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563502211 | ||||||||
| FaxNumber: | 2563013384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2009 | ||||||||
| LastUpdateDate: | 03/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | CROWE | ||||||||
| AuthorizedOfficialFirstName: | DANNY | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2563013414 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PARKWAY MEDICAL CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207RG0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207VG0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.