MEDICARE: PARKWAY SURGERY CENTER, 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1649655515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKWAY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	14201 DALLAS PKWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-2916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10561 JEFFREYS ST
Second Line	:	SUITE 130
City	:	HENDERSON
State	:	NV
Zip	:	89052-4266
Country	:	US
Telephone Number	:	702-724-8900
Fax Number	:	702-982-8854

Authorized Official
Title or Position	:	OFFICER
Name	:	ERIC BOON
Credential	:
Telephone Number	:	480-567-0269

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	05/12/2026

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