Basic Information
| Provider Information | |||||||||
| NPI: | 1427689652 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKVIEW MEDICAL CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 54 CLUB MANOR DR | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810081680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195957418 | ||||||||
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| Practice Location | |||||||||
| Address1: | 54 CLUB MANOR DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810082605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7915957650 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2020 | ||||||||
| LastUpdateDate: | 12/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | VAUGHT | ||||||||
| AuthorizedOfficialFirstName: | JACLYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR/QUALITY/ACCREDITATION/CRED | ||||||||
| AuthorizedOfficialTelephone: | 7195847309 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PARKVIEW MEDICAL CENTER, INC | ||||||||
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| NPICertificationDate: | 12/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.