Healthcare Provider Details

I. General information

NPI: 1558811562
Provider Name (Legal Business Name): PATHWAY HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HUGHES RD STE 101
MADISON AL
35758-2434
US

IV. Provider business mailing address

2911 TURTLE CREEK BLVD STE 1240
DALLAS TX
75219-6277
US

V. Phone/Fax

Practice location:
  • Phone: 256-325-1556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN BOECKMAN
Title or Position: MANAGER
Credential:
Phone: 214-522-7296