MEDICARE: PATHWAY HEALTHCARE, LLC

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	207QA0401X	Addiction Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1558811562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAY HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	2911 TURTLE CREEK BLVD STE 1240
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-6277
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 HUGHES RD STE 101
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-2434
Country	:	US
Telephone Number	:	256-325-1556
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DAN BOECKMAN
Credential	:
Telephone Number	:	214-522-7296

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	11/10/2016

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Directions to “PATHWAY HEALTHCARE, LLC ” Practice Location

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