Healthcare Provider Details

I. General information

NPI: 1407211824
Provider Name (Legal Business Name): PEAK VISTA COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2864 S CIRCLE DR SUITE 450
COLORADO SPRINGS CO
80906
US

IV. Provider business mailing address

3205 N ACADEMY BLVD SUITE 130
COLORADO SPRINGS CO
80917
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax: 719-344-7867
Mailing address:
  • Phone: 719-632-5700
  • Fax: 719-344-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateCO

VIII. Authorized Official

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