Provider Demographics
NPI:1346897956
Name:PATHWAY FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:PATHWAY FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-297-1268
Mailing Address - Street 1:407 LONGTREE LN
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-2427
Mailing Address - Country:US
Mailing Address - Phone:574-297-1268
Mailing Address - Fax:574-240-1113
Practice Address - Street 1:301 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2211
Practice Address - Country:US
Practice Address - Phone:574-240-1111
Practice Address - Fax:574-240-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty