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General NPI Number Information
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NPI Number | 1831547363
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Entity Type | Organization
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Legal Business Name | MOUNTAIN PEAKS FAMILY PRACTICE PC
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 836 S TOWNSEND AVE STE A
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City | MONTROSE
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State | CO
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Zip | 81401-4360
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Country | US
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Telephone | 970-615-9120
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Fax | 970-240-1139
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Provider Business Mailing Address
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Address Line | 836 S TOWNSEND AVE STE A
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City | MONTROSE
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State | CO
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Zip | 81401-4360
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Country | US
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Telephone | 970-615-9120
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Fax | 970-240-1139
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN K WADE
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Credential |
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Telephone | 970-216-6199
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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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