Provider Demographics
NPI:1811204183
Name:PARKE CLINIC, PSC
Entity Type:Organization
Organization Name:PARKE CLINIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
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:765-569-3182
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-0185
Mailing Address - Country:US
Mailing Address - Phone:765-569-3182
Mailing Address - Fax:765-569-2950
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003771A261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health