Provider Demographics
NPI:1043387517
Name:PARKVIEW OUTPATIENT MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PARKVIEW OUTPATIENT MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-353-1021
Mailing Address - Street 1:9041 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3900
Mailing Address - Country:US
Mailing Address - Phone:951-687-0692
Mailing Address - Fax:951-687-0692
Practice Address - Street 1:9041 MAGNOLIA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3900
Practice Address - Country:US
Practice Address - Phone:951-353-1021
Practice Address - Fax:951-687-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092140Medicaid
CAZZZ22895ZMedicare ID - Type UnspecifiedGROUP MEDICARE