MEDICARE: PARKVIEW ANCILLARY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1992972731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKVIEW ANCILLARY SERVICES

Provider Business Mailing Address
First Line	:	1600 N GRAND AVE
Second Line	:	STE 150
City	:	PUEBLO
State	:	CO
Zip	:	81003-2700
Country	:	US
Telephone Number	:	719-595-7705
Fax Number	:	719-595-7719

Provider Business Practice Location Address
First Line	:	56 CLUB MANOR DR
Second Line	:	STE 100
City	:	PUEBLO
State	:	CO
Zip	:	81008-1679
Country	:	US
Telephone Number	:	719-584-4767
Fax Number	:	719-584-4808

Authorized Official
Title or Position	:	CFO
Name	:	WILLIAM PATTERSON
Credential	:
Telephone Number	:	719-584-4000

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	07/20/2023

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Directions to “PARKVIEW ANCILLARY SERVICES ” Practice Location

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