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General NPI Number Information
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NPI Number | 1104462597
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Entity Type | Organization
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Legal Business Name | PARKVIEW ANCILLARY SERVICES
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Dates
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Enumeration Date | 11/21/2019
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 311 W 14TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-2705
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Country | US
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Telephone | 719-595-7585
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Fax | 719-595-7589
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Provider Business Mailing Address
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Address Line | 2695 ROCKY MOUNTAIN AVE STE 150
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City | LOVELAND
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State | CO
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Zip | 80538-9071
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | JANA CONROY
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Credential |
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Telephone | 719-595-7585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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