Healthcare Provider Details

I. General information

NPI: 1215394176
Provider Name (Legal Business Name): SILVER PEAK HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 SUN PEAK DR STE A102
PARK CITY UT
84098-6651
US

IV. Provider business mailing address

6300 SAGEWOOD DR STE 123
PARK CITY UT
84098-7502
US

V. Phone/Fax

Practice location:
  • Phone: 435-571-0716
  • Fax: 435-602-4404
Mailing address:
  • Phone: 435-571-0716
  • Fax: 435-602-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5633279
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5633279
License Number StateUT

VIII. Authorized Official

Name: AMANDA CURTIS
Title or Position: BILLING
Credential:
Phone: 480-208-6539