Healthcare Provider Details

I. General information

NPI: 1144763251
Provider Name (Legal Business Name): PEAK NEUROLOGY CORP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 FLINTRIDGE DR
COLORADO SPRINGS CO
80918-1881
US

IV. Provider business mailing address

5770 FLINTRIDGE DR STE 100
COLORADO SPRINGS CO
80918-1870
US

V. Phone/Fax

Practice location:
  • Phone: 719-445-9902
  • Fax: 719-387-0312
Mailing address:
  • Phone: 719-445-9902
  • Fax: 719-387-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberDR.0054025
License Number StateCO

VIII. Authorized Official

Name: BRADLEY PRIEBE
Title or Position: PHYSICIAN/CEO
Credential: DO
Phone: 719-445-9902