Organization Name: | PARKVIEW PEDIATRICS INC |
NPI Number: | 1063435998 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JILL A DUDIK BROSS (PRESIDENT) |
Mailing Address: | 615 S Division St Moses Lake |
State: | WA US |
Postal Code: | 988373800 |
Phone Number: | 5097669450 |
Fax Number: | 5097661954 |
NPI Enumeration Date: | 07/25/2006 |
NPI Last Update Date: | 09/30/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | 7590771 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |