Provider Demographics
NPI:1003355652
Name:PATHWAY HEALTHCARE TENNESSEE LLC
Entity Type:Organization
Organization Name:PATHWAY HEALTHCARE TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-522-8292
Mailing Address - Street 1:37 SANDSTONE CIR
Mailing Address - Street 2:SUITE 92
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2089
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 SANDSTONE CIR
Practice Address - Street 2:SUITE 92
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2089
Practice Address - Country:US
Practice Address - Phone:205-921-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty