Provider Demographics
NPI:1013425503
Name:PATHWAY HEALTHCARE- MISSISSIPPI LLC
Entity Type:Organization
Organization Name:PATHWAY HEALTHCARE- MISSISSIPPI LLC
Other - Org Name:PATHWAY HEALTHCARE LAUREL MS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-208-9312
Mailing Address - Street 1:1000 URBAN CENTER DR STE 600
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2584
Mailing Address - Country:US
Mailing Address - Phone:205-208-9312
Mailing Address - Fax:205-848-2227
Practice Address - Street 1:1 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5187
Practice Address - Country:US
Practice Address - Phone:601-883-0264
Practice Address - Fax:601-883-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty