Provider Demographics
NPI:1497076939
Name:PARKWAY REGIONAL MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:PARKWAY REGIONAL MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:105 NOLAN AVE
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041-8220
Mailing Address - Country:US
Mailing Address - Phone:270-472-5100
Mailing Address - Fax:270-472-5102
Practice Address - Street 1:105 NOLAN AVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-8220
Practice Address - Country:US
Practice Address - Phone:270-472-5100
Practice Address - Fax:270-472-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6396020002Medicare NSC