=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336450030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKVIEW ORTHOPAEDIC GROUP S C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2010
-----------------------------------------------------
Last Update Date | 11/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 GLENWOOD AVE STE 220
-----------------------------------------------------
City | JOLIET
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60435-5498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-729-3939
-----------------------------------------------------
Fax | 815-463-8268
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7600 W COLLEGE DR
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-361-0600
-----------------------------------------------------
Fax | 708-923-2529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REVENUE CYCLE MANAGER
-----------------------------------------------------
Name | MARIA FLAMBURIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-361-0600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 042619645
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------