Healthcare Provider Details

I. General information

NPI: 1174929947
Provider Name (Legal Business Name): PARKHILL MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ENCHANTED WAY SUITE 100
GRAPEVINE TX
76051-0965
US

IV. Provider business mailing address

1900 ENCHANTED WAY SUITE 100
GRAPEVINE TX
76051-0965
US

V. Phone/Fax

Practice location:
  • Phone: 817-421-1066
  • Fax: 817-886-3657
Mailing address:
  • Phone: 817-421-1066
  • Fax: 817-886-3657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: GLEN RAY WYANT
Title or Position: MANAGING PARTNER/CEO
Credential: M.D.
Phone: 817-421-1066