=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245522358
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHWAYS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2011
-----------------------------------------------------
Last Update Date | 05/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 COLLEEN CT NE
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20176-4825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-777-8898
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 COLLEEN CT NE
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20176-4825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-777-8898
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LOCAL CARE COORDINATOR
-----------------------------------------------------
Name | MS. PAMELA CRONIN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 703-889-7358
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 000118165
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------