Healthcare Provider Details

I. General information

NPI: 1255386173
Provider Name (Legal Business Name): PEAK MEDICAL MONTANA OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 7TH ST
WHITEFISH MT
59937-2850
US

IV. Provider business mailing address

1305 7TH ST
WHITEFISH MT
59937-2850
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-3557
  • Fax:
Mailing address:
  • Phone: 406-862-3557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12679
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12679
License Number StateMT

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4752