Basic Information
| Provider Information | |||||||||
| NPI: | 1912228107 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKWAY BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 COLLEGE PL | ||||||||
| Address2: | SUITE B-100 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288012483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282545008 | ||||||||
| FaxNumber: | 8282545808 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 COLLEGE PL | ||||||||
| Address2: | SUITE B-100 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288012483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282545008 | ||||||||
| FaxNumber: | 8282545808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2010 | ||||||||
| LastUpdateDate: | 06/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | CLONTZ | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8282545008 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | MHL011273 | NC | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 018PV | 01 | NC | BCBS | OTHER | 6005944 | 05 | NC | MEDICAID |