Provider Demographics
NPI:1831919851
Name:PARKWAY PEDIATRIC MEDICAL GROUP INC
Entity type:Organization
Organization Name:PARKWAY PEDIATRIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-651-9210
Mailing Address - Street 1:5000 PARKWAY CALABASAS STE 203
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3924
Mailing Address - Country:US
Mailing Address - Phone:818-651-9210
Mailing Address - Fax:818-584-7934
Practice Address - Street 1:5000 PARKWAY CALABASAS STE 203
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3924
Practice Address - Country:US
Practice Address - Phone:818-651-9210
Practice Address - Fax:818-584-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty