Provider Demographics
NPI:1417935115
Name:PARKWAY MEDICAL, PLC
Entity Type:Organization
Organization Name:PARKWAY MEDICAL, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-348-3200
Mailing Address - Street 1:6565 E GREENWAY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2056
Mailing Address - Country:US
Mailing Address - Phone:480-348-3200
Mailing Address - Fax:480-348-3210
Practice Address - Street 1:6565 E GREENWAY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2056
Practice Address - Country:US
Practice Address - Phone:480-348-3200
Practice Address - Fax:480-348-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03D1000564OtherCLIA ID NUMBER
AZ=========OtherTAX IDENTIFICATION NUMBER
AZZ70527Medicare ID - Type UnspecifiedPRACTICE MEDICARE NUMBER