Healthcare Provider Details

I. General information

NPI: 1124320106
Provider Name (Legal Business Name): PEAK VISTA COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LYCKMAN DRIVE
FOUNTAIN CO
80817
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: 719-322-0776
Mailing address:
  • Phone: 719-632-5700
  • Fax: 719-344-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: RYAN SPILLANE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 719-344-7135