Healthcare Provider Details

I. General information

NPI: 1205051232
Provider Name (Legal Business Name): PEAK VISTA COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 PRINTERS PARKWAY SUITE 230
COLORADO SPRINGS CO
80910
US

IV. Provider business mailing address

3205 N ACADMEY BLVD SUITE 130
COLORADO SPRINGS CO
80917
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax: 719-633-5492
Mailing address:
  • Phone: 719-632-5700
  • Fax: 719-344-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18812
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateCO

VIII. Authorized Official

Name: TRACY NARVET
Title or Position: CFO
Credential:
Phone: 719-344-6188