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General NPI Number Information
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NPI Number | 1144763251
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Entity Type | Organization
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Legal Business Name | PEAK NEUROLOGY CORP PC
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 5770 FLINTRIDGE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-1881
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Country | US
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Telephone | 719-445-9902
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Fax | 719-387-0312
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Provider Business Mailing Address
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Address Line | 5770 FLINTRIDGE DR STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-1870
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Country | US
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Telephone | 719-445-9902
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Fax | 719-387-0312
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Authorized Official
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Title or Position | PHYSICIAN/CEO
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Name | BRADLEY PRIEBE
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Credential | DO
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Telephone | 719-445-9902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | DR.0054025
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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