1366407603 NPI number — PARKVIEW HOSPITAL, INC.

Table of content: (NPI 1366407603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366407603 NPI number — PARKVIEW HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKVIEW 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:
Provider Other Organization Name Type Code:
6
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:
1366407603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5600
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:
46895-5600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-373-8406
Provider Business Mailing Address Fax Number:
260-373-8469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11109 PARKVIEW PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46845-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-266-1000
Provider Business Practice Location Address Fax Number:
260-373-8446
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RISSER
Authorized Official First Name:
STANTON
Authorized Official Middle Name:
Authorized Official Title or Position:
ACFO
Authorized Official Telephone Number:
260-266-9380

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  060050201 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336I0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100268480A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1674 . This is a "PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11033A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 909254400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1500021 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30 1951522 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3161 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013112800 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1507461 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: HOS0021N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000097670 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01340272 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40 1951522 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6723282 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 71953601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP31257 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000001907 . This is a "MPLAN" identifier . This identifiers is of the category "OTHER".




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