Provider Demographics
NPI:1558811562
Name:PATHWAY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:PATHWAY HEALTHCARE, LLC
Other - Org Name:PATHWAY PARTNERS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-522-7296
Mailing Address - Street 1:2911 TURTLE CREEK BLVD STE 1240
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-6277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 HUGHES RD STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2434
Practice Address - Country:US
Practice Address - Phone:256-325-1556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty