Healthcare Provider Details

I. General information

NPI: 1992972731
Provider Name (Legal Business Name): PARKVIEW ANCILLARY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CLUB MANOR DR STE 100
PUEBLO CO
81008-1679
US

IV. Provider business mailing address

1600 N GRAND AVE STE 150
PUEBLO CO
81003-2700
US

V. Phone/Fax

Practice location:
  • Phone: 719-584-4767
  • Fax: 719-584-4808
Mailing address:
  • Phone: 719-595-7705
  • Fax: 719-595-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM PATTERSON
Title or Position: CFO
Credential:
Phone: 719-584-4000