Provider Demographics
NPI:1093365074
Name:PARKVIEW ANCILLARY SERVICES
Entity Type:Organization
Organization Name:PARKVIEW ANCILLARY SERVICES
Other - Org Name:PARKVIEW INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-584-4290
Mailing Address - Street 1:58 CLUB MANOR DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1601
Mailing Address - Country:US
Mailing Address - Phone:719-595-7417
Mailing Address - Fax:719-542-0809
Practice Address - Street 1:4491 BENT BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:CO
Practice Address - Zip Code:81019-9990
Practice Address - Country:US
Practice Address - Phone:719-595-7525
Practice Address - Fax:719-595-7965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKVIEW ANCILLARY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-12
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99437767Medicaid