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
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207T00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansNeurological Surgery 
207X00000X CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic Surgery 
2081N0008X CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
2084N0400X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084P0800X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
208600000X CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 
207Q00000X CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 
207QA0000X CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
207RC0000X CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RC0200X CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RE0101X CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
207RG0100X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
207RI0200X CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
208G00000X CON193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 
207R00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
1617775405CO MEDICAID
1270137805CO MEDICAID
2453971605CO MEDICAID
2973486005CO MEDICAID
8153186905CO MEDICAID
9568287205CO MEDICAID
2683477405CO MEDICAID
6302734805CO MEDICAID
7480858305CO MEDICAID
9647025905CO MEDICAID
9943776705CO MEDICAID
0772577905CO MEDICAID
1458926505CO MEDICAID
2697389805CO MEDICAID
2772875705CO MEDICAID
4947854105CO MEDICAID
3608337205CO MEDICAID
3882958405CO MEDICAID
5613907105CO MEDICAID
5927074805CO MEDICAID
8923675105CO MEDICAID
6772058705CO MEDICAID
2087557605CO MEDICAID
2307305505CO MEDICAID
2958885505CO MEDICAID
2258422605CO MEDICAID


Home