Basic Information
| Provider Information | |||||||||
| NPI: | 1336450030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKVIEW ORTHOPAEDIC GROUP S C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7600 W COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604631001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083610600 | ||||||||
| FaxNumber: | 7089232529 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 GLENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604355574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157293939 | ||||||||
| FaxNumber: | 8157293936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2010 | ||||||||
| LastUpdateDate: | 03/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | PRICE | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 7083610600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 042619645 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 605460 | 01 | IL | PTAN | OTHER | 209984 | 01 | IL | PTAN | OTHER |