Provider Demographics
NPI:1063757227
Name:PARKVIEW ORTHO CENTER, LLC
Entity type:Organization
Organization Name:PARKVIEW ORTHO CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:RISSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-266-9380
Mailing Address - Street 1:10501 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1700
Mailing Address - Country:US
Mailing Address - Phone:260-373-7100
Mailing Address - Fax:260-373-7110
Practice Address - Street 1:11420 PARKVIEW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1729
Practice Address - Country:US
Practice Address - Phone:260-482-5194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC HOSPITAL AT PARKVIEW NORTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-29
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical