Healthcare Provider Details

I. General information

NPI: 1285278515
Provider Name (Legal Business Name): PARKVIEW ANCILLARY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W 13TH ST
PUEBLO CO
81003-3704
US

IV. Provider business mailing address

408 N MAIN ST
PUEBLO CO
81003-3123
US

V. Phone/Fax

Practice location:
  • Phone: 719-595-7474
  • Fax: 719-595-7199
Mailing address:
  • Phone: 719-595-7417
  • Fax: 719-542-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DARRIN R SMITH
Title or Position: SR. VP/COO
Credential:
Phone: 719-584-4290