Basic Information
| Provider Information | |||||||||
| NPI: | 1528608304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKVIEW MEDICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 W 16TH ST | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195844000 | ||||||||
| FaxNumber: | 7195844569 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 W 15TH ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195847300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2020 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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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: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.