Basic Information
| Provider Information | |||||||||
| NPI: | 1730144684 | ||||||||
| 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 | ||||||||
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| FaxNumber: | 7195844569 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 W 16TH ST | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195844266 | ||||||||
| FaxNumber: | 7195844569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 05/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | BAXTER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7195844573 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04000113 | 05 | CO | MEDICAID | PAF9004 | 01 | CO | PHYSICIAN GROUP - BLUE CR | OTHER | CF9004 | 01 | CO | PHYSICIAN GROUP | OTHER |