Provider Demographics
NPI:1346970928
Name:PARKVIEW ANCILLARY SERVICES
Entity Type:Organization
Organization Name:PARKVIEW ANCILLARY SERVICES
Other - Org Name:PARKVIEW NEUROLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-595-7417
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 1:1619 N GREENWOOD ST STE 210
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2656
Practice Address - Country:US
Practice Address - Phone:719-595-7760
Practice Address - Fax:719-595-7765
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKVIEW ANCILLARY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-15
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center