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NPI Code Detail

MEDICARE: MALLORY GALLOWAY PA-C

MEDICARE: MALLORY GALLOWAY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant10002464AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184121436
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY GALLOWAY PA-C
Provider Business Mailing Address
First Line : 701 E COUNTY LINE RD STE 101
Second Line :
City : GREENWOOD
State : IN
Zip : 46143-1070
Country : US
Telephone Number : 317-885-2860
Fax Number : 317-885-2869
Provider Business Practice Location Address
First Line : 2400 17TH ST
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-5351
Country : US
Telephone Number : 812-376-5757
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2018
Last Update Date : 03/02/2026

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Directions to “ MALLORY GALLOWAY PA-C” Practice Location

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