PARKVIEW HOSPITAL, INC.

Provider Demographics

• NPI: 1366407603
• Name: PARKVIEW HOSPITAL, INC.
• Entity type: Organization
• Organization Name: PARKVIEW HOSPITAL, INC.
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: ACFO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: STANTON
• Authorized Official - Last Name: RISSER
• Authorized Official - Phone: 260-266-9380
• Mailing Address - Street 1: PO BOX 5600
• Mailing Address - City: FORT WAYNE
• Mailing Address - State: IN
• Mailing Address - Zip Code: 46895-5600
• Mailing Address - Country: US
• Mailing Address - Phone: 260-373-8406
• Mailing Address - Fax: 260-373-8469
• Practice Address - Street 1: 11109 PARKVIEW PLAZA DR
• Practice Address - City: FORT WAYNE
• Practice Address - State: IN
• Practice Address - Zip Code: 46845-1701
• Practice Address - Country: US
• Practice Address - Phone: 260-266-1000
• Practice Address - Fax: 260-373-8446
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: PARKVIEW HOSPITAL, INC.
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-04-19
• Last Update Date: 2024-10-31

Provider Licenses

State	License ID	Taxonomies
		3336I0012X, 3336C0003X, 282N00000X
IN	060050201	282N00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital
No	3336I0012X	Suppliers	Pharmacy	Institutional Pharmacy
No	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	100268480A	Medicaid
	1674	Other	PHP
SC	11033A	Medicaid
FL	909254400	Medicaid
NC	1500021	Medicaid
MI	30 1951522	Medicaid
TN	3161	Medicaid
MO	013112800	Medicaid
	1507461	Other	NCPDP
AL	HOS0021N	Medicaid
	000000097670	Other	ANTHEM
KY	01340272	Medicaid
MI	40 1951522	Medicaid
OH	6723282	Medicaid
TX	71953601	Medicaid
CA	XHSP31257	Medicaid
	000000001907	Other	MPLAN
IN	150021	Medicare Oscar/Certification
CA	XHSP31257	Medicaid
FL	909254400	Medicaid
MI	30 1951522	Medicaid