Provider Demographics
NPI:1093355877
Name:PARKVIEW MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:PARKVIEW MEDICAL CENTER, INC
Other - Org Name:SLEEP LAB PUEBLO WEST
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR/QUALITY/ACCREDITATION/CRED
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-584-7309
Mailing Address - Street 1:400 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2745
Mailing Address - Country:US
Mailing Address - Phone:719-595-7418
Mailing Address - Fax:719-584-4569
Practice Address - Street 1:899 E INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1442
Practice Address - Country:US
Practice Address - Phone:719-288-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic