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NPI Code Detail

MEDICARE: SILVER PEAK MEDICAL LLC

MEDICARE: SILVER PEAK MEDICAL LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TA0400XAddiction (Substance Use Disorder) Psychologist5633279UT
2207R00000XInternal Medicine Physician5633279UT
3207RA0401XAddiction Medicine (Internal Medicine) Physician5633279UT

General Provider Information

NPI Number : 1265899009
Entity Type Code : Organization
Provider Name (Legal Business Name) : SILVER PEAK MEDICAL LLC
Provider Business Mailing Address
First Line : 6300 SAGEWOOD DR STE 123
Second Line :
City : PARK CITY
State : UT
Zip : 84098-7502
Country : US
Telephone Number : 435-571-0245
Fax Number : 435-602-4405
Provider Business Practice Location Address
First Line : 1817 S MAIN ST STE 8
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-7060
Country : US
Telephone Number : 435-571-0245
Fax Number : 435-602-4405
Authorized Official
Title or Position : BILLING
Name : AMANDA CURTIS
Credential :
Telephone Number : 480-208-6539
Provider Enumeration Date : 01/25/2016
Last Update Date : 01/25/2016

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