Provider Demographics
NPI:1245755990
Name:PATHWAY HEALTHCARE- COLUMBUS, MS LLC
Entity Type:Organization
Organization Name:PATHWAY HEALTHCARE- COLUMBUS, MS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-265-6025
Mailing Address - Street 1:37 SANDSTONE CIR STE 92
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3168
Mailing Address - Country:US
Mailing Address - Phone:731-265-6025
Mailing Address - Fax:731-265-6028
Practice Address - Street 1:3600 BLUECUTT RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1303
Practice Address - Country:US
Practice Address - Phone:731-265-6025
Practice Address - Fax:731-265-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty