Healthcare Provider Details

I. General information

NPI: 1609876556
Provider Name (Legal Business Name): PEAK ONE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PEAK ONE DRIVE
FRISCO CO
80443
US

IV. Provider business mailing address

PO BOX 5541
DENVER CO
80217-5541
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-1458
  • Fax: 970-668-1703
Mailing address:
  • Phone: 970-668-1458
  • Fax: 970-668-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0173
License Number StateCO

VIII. Authorized Official

Name: PETER C JANES
Title or Position: PRESIDENT, BOARD OF MANAGERS
Credential: MD
Phone: 970-668-1458