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General NPI Number Information
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NPI Number | 1366088619
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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 | 02/03/2022
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Provider Practice Location Address
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Address Line | 4100 JERRY MURPHY
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City | PUEBLO
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State | CO
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Zip | 81001-1046
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Country | US
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Telephone | 719-545-9713
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Fax | 719-545-6826
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Provider Business Mailing Address
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Address Line | 58 CLUB MANOR DR
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City | PUEBLO
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State | CO
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Zip | 81008-1601
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Country | US
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Telephone | 719-595-7417
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Fax | 719-542-0809
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Authorized Official
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Title or Position | SR. VP/COO
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Name | DARRIN R SMITH
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Credential |
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Telephone | 719-584-4290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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