Provider Demographics
NPI:1063601094
Name:PARKWAY FAMILY PRACTICE
Entity type:Organization
Organization Name:PARKWAY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-640-2808
Mailing Address - Street 1:2834 MOODY PKWY
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3101
Mailing Address - Country:US
Mailing Address - Phone:205-640-2808
Mailing Address - Fax:205-640-2810
Practice Address - Street 1:2834 MOODY PKWY
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3101
Practice Address - Country:US
Practice Address - Phone:205-640-2808
Practice Address - Fax:205-640-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529912430Medicaid
AL=========OtherTAX ID