MEDICARE: PARKWAY HEALTH CARE CENTER, L.L.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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1295189645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKWAY HEALTH CARE CENTER, L.L.C.

Provider Business Mailing Address
First Line	:	1869 CRAIG PARK CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4122
Country	:	US
Telephone Number	:	314-543-3816
Fax Number	:	314-543-3880

Provider Business Practice Location Address
First Line	:	2323 SWOPE PKWY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-2638
Country	:	US
Telephone Number	:	816-924-1122
Fax Number	:	816-924-0955

Authorized Official
Title or Position	:	IN-HOUSE COUNSEL
Name	:	MR. ROBERT J CRADDICK
Credential	:
Telephone Number	:	314-543-3816

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/21/2016

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