Provider Demographics
NPI:1851185433
Name:ROADWAY PRIMARY CARE PLLC
Entity type:Organization
Organization Name:ROADWAY PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTAU
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:945-954-0574
Mailing Address - Street 1:910 N DAVIS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3200
Mailing Address - Country:US
Mailing Address - Phone:945-954-0574
Mailing Address - Fax:972-957-5215
Practice Address - Street 1:910 N DAVIS DR STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3200
Practice Address - Country:US
Practice Address - Phone:945-954-0574
Practice Address - Fax:972-957-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty