Healthcare Provider Details

I. General information

NPI: 1992965032
Provider Name (Legal Business Name): PARKWAY MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 MANCHESTER SQUARE SHPG CTR
MANCHESTER KY
40962-8781
US

IV. Provider business mailing address

PO BOX 369
MANCHESTER KY
40962-0369
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-5115
  • Fax: 606-598-7179
Mailing address:
  • Phone: 606-598-5115
  • Fax: 606-598-7179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JUDY REYNOLDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 606-598-5115