Provider Demographics
NPI:1043583651
Name:PARKWAY REGIONAL MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:PARKWAY REGIONAL MEDICAL CLINIC INC
Other - Org Name:TRI CITIES EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-628-6038
Mailing Address - Street 1:2002 HOLIDAY LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041-8468
Mailing Address - Country:US
Mailing Address - Phone:615-465-3228
Mailing Address - Fax:615-465-2894
Practice Address - Street 1:2002 HOLIDAY LN
Practice Address - Street 2:SUITE 500
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-8468
Practice Address - Country:US
Practice Address - Phone:615-465-3228
Practice Address - Fax:615-465-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1007341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY135413Medicare PIN