Provider Demographics
NPI: | 1932130952 |
---|---|
Name: | PARKVIEW HEALTH SYSTEM INC |
Entity Type: | Organization |
Organization Name: | PARKVIEW HEALTH SYSTEM INC |
Other - Org Name: | PARKVIEW PHYSICIANS GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KRISTINA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BIGELOW |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 260-266-1403 |
Mailing Address - Street 1: | 11109 PARKVIEW PLAZA DR # 117 |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT WAYNE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46845-1701 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 260-373-9700 |
Mailing Address - Fax: | 260-373-9740 |
Practice Address - Street 1: | 3909 NEW VISION DR |
Practice Address - Street 2: | |
Practice Address - City: | FORT WAYNE |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46845-1725 |
Practice Address - Country: | US |
Practice Address - Phone: | 260-469-6602 |
Practice Address - Fax: | 260-969-3065 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | PARKVIEW HEALTH SYSTEM, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-07-06 |
Last Update Date: | 2022-03-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 207KA0200X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | Group - Multi-Specialty |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RH0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0102X | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | Group - Multi-Specialty |
No | 2086S0127X | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | Group - Multi-Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 100268490 | Medicaid | |
IN | 200263700 | Medicaid | |
IN | 200956680 | Medicaid | |
IN | 200263700 | Medicaid |