Provider Demographics
NPI:1508950171
Name:PARKVIEW PROFESSIONAL PROGRAMS, INC.
Entity Type:Organization
Organization Name:PARKVIEW PROFESSIONAL PROGRAMS, INC.
Other - Org Name:PARKVIEW HEALTH LABORATORIES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VP -- CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-373-8407
Mailing Address - Street 1:PO BOX 5600
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46895-5600
Mailing Address - Country:US
Mailing Address - Phone:260-373-7008
Mailing Address - Fax:260-373-7059
Practice Address - Street 1:11109 PARKVIEW PLAZA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:260-373-9420
Practice Address - Fax:260-373-9464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKVIEW PROFESSIONAL PROGRAMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000097317OtherANTHEM
806088OtherBLACK LUNG
2814OtherPHP
OH2875661Medicaid
1000514OtherTRICARE
IN100282380Medicaid
IN100282380Medicaid