Healthcare Provider Details

I. General information

NPI: 1891176590
Provider Name (Legal Business Name): PARKVIEW WABASH HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 JOHN KISSINGER DR.
WABASH IN
46992-1648
US

IV. Provider business mailing address

10501 CORPORATE DR
FORT WAYNE IN
46845-1700
US

V. Phone/Fax

Practice location:
  • Phone: 260-563-3131
  • Fax:
Mailing address:
  • Phone: 260-373-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANNE WICKENS
Title or Position: CFO
Credential:
Phone: 260-266-9313