Provider Demographics
NPI:1518181015
Name:PARKVIEW FAMILY PRACTICE, P.C.
Entity Type:Organization
Organization Name:PARKVIEW FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIBLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-672-4587
Mailing Address - Street 1:109 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2223
Mailing Address - Country:US
Mailing Address - Phone:815-672-4587
Mailing Address - Fax:815-673-3582
Practice Address - Street 1:109 E ELM ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2223
Practice Address - Country:US
Practice Address - Phone:815-672-4587
Practice Address - Fax:815-673-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD14438Medicare UPIN
ILS43287Medicare UPIN
ILK13146Medicare UPIN
ILG63975Medicare UPIN
ILH38971Medicare UPIN