Provider Demographics
NPI:1972145951
Name:PARKVIEW ANCILLARY SERVICES
Entity Type:Organization
Organization Name:PARKVIEW ANCILLARY SERVICES
Other - Org Name:PARKVIEW MEDICAL GROUP PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-584-4290
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 1:1600 N. GRAND AVE.
Practice Address - Street 2:STE. 520
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2757
Practice Address - Country:US
Practice Address - Phone:719-562-2360
Practice Address - Fax:719-562-2399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKVIEW ANCILLARY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-11
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000158473Medicaid