Basic Information
| Provider Information | |||||||||
| NPI: | 1376590315 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKWAY CARDIOLOGY ASSOCIATES P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654824078 | ||||||||
| FaxNumber: | 8654824960 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654824078 | ||||||||
| FaxNumber: | 8654824960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 02/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | NORSTEDT | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8654824078 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | CA3640 | 01 | TN | RAILROAD MEDICARE | OTHER |