=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447659669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKWAY HEALTH CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2014
-----------------------------------------------------
Last Update Date | 08/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14324 CHENAL PKWY
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-5805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-202-1659
-----------------------------------------------------
Fax | 501-202-1693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14324 CHENAL PKWY
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-5805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-202-1659
-----------------------------------------------------
Fax | 501-202-1693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. STEVEN A GATES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-202-1659
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 432
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------