Provider Demographics
NPI:1316029069
Name:PARKSIDE CARDIOLOGY LLC
Entity Type:Organization
Organization Name:PARKSIDE CARDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAVEZ-VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-471-1775
Mailing Address - Street 1:215 PARKSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910
Mailing Address - Country:US
Mailing Address - Phone:719-471-1775
Mailing Address - Fax:719-632-6055
Practice Address - Street 1:215 PARKSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910
Practice Address - Country:US
Practice Address - Phone:719-471-1775
Practice Address - Fax:719-632-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01294461Medicaid
CO31380328Medicaid
CO01280569Medicaid
CO01359846Medicaid
CO20058837Medicaid
CO01306810Medicaid
G65519Medicare UPIN
CO01306810Medicaid
I03178Medicare UPIN
C532108Medicare ID - Type Unspecified
C458548Medicare ID - Type Unspecified
CO20058837Medicaid
CO01280569Medicaid
CO31380328Medicaid
H10876Medicare UPIN
CN7028Medicare ID - Type Unspecified
CN7048Medicare ID - Type Unspecified
CO01294461Medicaid