1245259878 NPI number — PARKVIEW WABASH HOSPITAL, INC.

Table of content: (NPI 1245259878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245259878 NPI number — PARKVIEW WABASH HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKVIEW WABASH HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARKVIEW WABASH HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245259878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10501 CORPORATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46845-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-373-8406
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 JOHN KISSINGER DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WABASH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46992-1648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-563-3131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WICKENS
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
260-266-9313

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  14-005094-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 06-005094-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 18-005094-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036676500 . This is a "BLACK LUNG" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100270180A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01340421 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201277260A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000097837 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 304685582 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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