Provider Demographics
NPI:1851945182
Name:PARKVIEW MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PARKVIEW MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-766-9450
Mailing Address - Street 1:615 S DIVISION ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-3800
Mailing Address - Country:US
Mailing Address - Phone:509-766-9450
Mailing Address - Fax:509-766-1954
Practice Address - Street 1:615 S DIVISION ST STE A
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-3800
Practice Address - Country:US
Practice Address - Phone:509-766-9450
Practice Address - Fax:509-766-1954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKVIEW MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty