Basic Information
| Provider Information | |||||||||
| NPI: | 1821087065 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARKVIEW HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2115 PARKVIEW DR | ||||||||
| Address2: | |||||||||
| City: | EL RENO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730362109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052622640 | ||||||||
| FaxNumber: | 4054222521 | ||||||||
| Practice Location | |||||||||
| Address1: | 2115 PARKVIEW DR | ||||||||
| Address2: | |||||||||
| City: | EL RENO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730362109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052622640 | ||||||||
| FaxNumber: | 4054222521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 05/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | CARMICHAEL | ||||||||
| AuthorizedOfficialFirstName: | LUCINDA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM CEO | ||||||||
| AuthorizedOfficialTelephone: | 4052951000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 2225 | OK | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100700930 A | 05 | OK | MEDICAID |