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General NPI Number Information
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NPI Number | 1790506376
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Entity Type | Organization
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Legal Business Name | PARKVIEW KOSCIUSKO SURGERY ONE, LLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 335 E 200N
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City | WARSAW
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State | IN
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Zip | 46582-7855
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Country | US
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Telephone | 574-372-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 PRODUCTION RD
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City | FORT WAYNE
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State | IN
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Zip | 46808-1167
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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 REIMBURSEMENT
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Name | SHANNON PERRY
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Credential |
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Telephone | 260-437-7558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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