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General NPI Number Information
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NPI Number | 1316601156
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Entity Type | Organization
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Legal Business Name | PEAK FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 1495 PARKWAY DR STE C
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City | BLACKFOOT
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State | ID
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Zip | 83221-1639
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Country | US
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Telephone | 208-643-4231
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Fax | 208-643-4235
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Provider Business Mailing Address
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Address Line | 1495 PARKWAY DR STE C
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City | BLACKFOOT
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State | ID
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Zip | 83221-1639
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Country | US
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Telephone | 208-643-4231
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Fax | 208-643-4235
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL J BARNEY
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Credential | NP
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Telephone | 208-643-4231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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