Provider Demographics
NPI:1285748962
Name:PARKWAY MEDICAL GROUP, PC
Entity type:Organization
Organization Name:PARKWAY MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-438-4111
Mailing Address - Street 1:108 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE G-50
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2741
Mailing Address - Country:US
Mailing Address - Phone:931-438-4111
Mailing Address - Fax:931-438-6108
Practice Address - Street 1:108 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE G-50
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2741
Practice Address - Country:US
Practice Address - Phone:931-438-4111
Practice Address - Fax:931-438-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1285748962Medicare NSC