Parkview Kosciusko Surgery One, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PARKVIEW KOSCIUSKO SURGERY ONE, LLC

Practice address

335 E 200N
Warsaw, IN 46582-7855

Phone

(260) 266-6870

NPI assigned

Oct 17, 2024

Last updated

Jul 22, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jessica Lee-Hansen

Title

Cfo

Phone

(312) 388-0125

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784678400000",
    "number": "1790506376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 PRODUCTION RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468081167",
            "telephone_number": "260-266-6870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 E 200N",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465827855",
            "telephone_number": "260-266-6870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKVIEW KOSCIUSKO SURGERY ONE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-17",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A",
        "authorized_official_last_name": "LEE-HANSEN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "312-388-0125",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sung Jae Park, M.D.
• Amber Rae Parker, PTA
• Kellie R. Parker, NP
• Kimberly Parker, RN
• Marlene Parker, HSPP
• Karlee Paul
• Polly Ann Pavey, MSW
• Peak Performance Orthopedic & Sports Physical Therapy, P.C.
• Kristi R Pentz
• Felanny Perez Cuevas

• Ambulatory Surgical Clinic/Center in Warsaw, IN
• Providers in Warsaw, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.