Provider Demographics
NPI:1376698183
Name:PARKE CLINIC PC
Entity Type:Organization
Organization Name:PARKE CLINIC PC
Other - Org Name:PARKE CLINIC LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SWAIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-832-9301
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-0266
Mailing Address - Country:US
Mailing Address - Phone:765-832-9301
Mailing Address - Fax:765-832-9302
Practice Address - Street 1:503 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1008
Practice Address - Country:US
Practice Address - Phone:765-569-3182
Practice Address - Fax:765-569-2950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKE CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-24
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100283250Medicaid
IN100283250Medicaid