Provider Demographics
NPI:1366446189
Name:PARKWAY SURGERY CENTER, LLC.
Entity Type:Organization
Organization Name:PARKWAY SURGERY CENTER, LLC.
Other - Org Name:PARKWAY SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:100 N GREEN VALLEY PKWY
Mailing Address - Street 2:STE 125
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6392
Mailing Address - Country:US
Mailing Address - Phone:702-616-4954
Mailing Address - Fax:702-269-0436
Practice Address - Street 1:100 N GREEN VALLEY PKWY
Practice Address - Street 2:STE 125
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6392
Practice Address - Country:US
Practice Address - Phone:702-616-4954
Practice Address - Fax:702-269-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2147ASC261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV10-6133OtherCSHCN
NV0046-02011Medicaid
NV490004254OtherRAILROAD MEDICARE
NVNV1692OtherBCBS
NV490004254OtherRAILROAD MEDICARE
NVV31455Medicare PIN