Provider Demographics
NPI:1174929947
Name:PARKHILL MEDICAL, LLC
Entity type:Organization
Organization Name:PARKHILL MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WYANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-421-1066
Mailing Address - Street 1:1900 ENCHANTED WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-0965
Mailing Address - Country:US
Mailing Address - Phone:817-421-1066
Mailing Address - Fax:817-886-3657
Practice Address - Street 1:1900 ENCHANTED WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-0965
Practice Address - Country:US
Practice Address - Phone:817-421-1066
Practice Address - Fax:817-886-3657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty