Provider Demographics
NPI:1245259878
Name:PARKVIEW WABASH HOSPITAL, INC.
Entity type:Organization
Organization Name:PARKVIEW WABASH HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACFO
Authorized Official - Prefix:
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:RISSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-266-9380
Mailing Address - Street 1:10501 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1700
Mailing Address - Country:US
Mailing Address - Phone:260-373-8406
Mailing Address - Fax:
Practice Address - Street 1:10 JOHN KISSINGER DRIVE
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1648
Practice Address - Country:US
Practice Address - Phone:260-563-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14-005094-1282N00000X
IN06-005094-1282NC0060X
IN18-005094-1282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097837OtherANTHEM BLUE CROSS
IN201277260AMedicaid
KY01340421Medicaid
IN036676500OtherBLACK LUNG
MI304685582Medicaid
IN100270180AMedicaid
IN201277260AMedicaid