Provider Demographics
NPI:1518962109
Name:PARKVIEW HOSPITAL, INC.
Entity type:Organization
Organization Name:PARKVIEW HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKENS
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 1:1900 CAREW ST
Practice Address - Street 2:STE 6
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4765
Practice Address - Country:US
Practice Address - Phone:260-373-9800
Practice Address - Fax:260-373-9949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKVIEW HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-20
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
IN050083471251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200034360CMedicaid
IN200034360EMedicaid
700011OtherBLACK LUNG
IN200034360BMedicaid
IN200121480AMedicaid
IN200034360AMedicaid
IN200121480BMedicaid
IN200121480CMedicaid
IN200121480DMedicaid
000000097668OtherANTHEM
IN200121480DMedicaid
700011OtherBLACK LUNG