Basic Information
Provider Information | |||||||||
NPI: | 1982878765 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PARKVIEW ANCILLARY SERVICES CORPORATION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 58 CLUB MANOR DR. | ||||||||
Address2: |   | ||||||||
City: | PUEBLO | ||||||||
State: | CO | ||||||||
PostalCode: | 810081601 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7195844045 | ||||||||
FaxNumber: | 7195420809 | ||||||||
Practice Location | |||||||||
Address1: | 1619 N. GREENWOOD AVE. | ||||||||
Address2: | STE. 106 | ||||||||
City: | PUEBLO | ||||||||
State: | CO | ||||||||
PostalCode: | 810032655 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7195844045 | ||||||||
FaxNumber: | 7195420809 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/14/2008 | ||||||||
LastUpdateDate: | 05/23/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BARNES | ||||||||
AuthorizedOfficialFirstName: | LESLIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
AuthorizedOfficialTelephone: | 7195844573 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/27/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |   | 207X00000X |   | CO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 2081N0008X |   | CO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Neuromuscular Medicine | 2084N0400X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084P0800X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 208600000X |   | CO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |   | 207Q00000X |   | CO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   | 207QA0000X |   | CO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | 207RC0000X |   | CO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0200X |   | CO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RE0101X |   | CO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RG0100X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RI0200X |   | CO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 208G00000X |   | CO | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |   | 207R00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 16177754 | 05 | CO |   | MEDICAID | 12701378 | 05 | CO |   | MEDICAID | 24539716 | 05 | CO |   | MEDICAID | 29734860 | 05 | CO |   | MEDICAID | 81531869 | 05 | CO |   | MEDICAID | 95682872 | 05 | CO |   | MEDICAID | 26834774 | 05 | CO |   | MEDICAID | 63027348 | 05 | CO |   | MEDICAID | 74808583 | 05 | CO |   | MEDICAID | 96470259 | 05 | CO |   | MEDICAID | 99437767 | 05 | CO |   | MEDICAID | 07725779 | 05 | CO |   | MEDICAID | 14589265 | 05 | CO |   | MEDICAID | 26973898 | 05 | CO |   | MEDICAID | 27728757 | 05 | CO |   | MEDICAID | 49478541 | 05 | CO |   | MEDICAID | 36083372 | 05 | CO |   | MEDICAID | 38829584 | 05 | CO |   | MEDICAID | 56139071 | 05 | CO |   | MEDICAID | 59270748 | 05 | CO |   | MEDICAID | 89236751 | 05 | CO |   | MEDICAID | 67720587 | 05 | CO |   | MEDICAID | 20875576 | 05 | CO |   | MEDICAID | 23073055 | 05 | CO |   | MEDICAID | 29588855 | 05 | CO |   | MEDICAID | 22584226 | 05 | CO |   | MEDICAID |