MEDICARE: PEAK VISTA COMMUNITY HEALTH CENTERS

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
1	261QF0400X	Federally Qualified Health Center (FQHC)		CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285964262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK VISTA COMMUNITY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	3205 N ACADEMY BLVD
Second Line	:	SUITE 130
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:	719-344-7836

Provider Business Practice Location Address
First Line	:	2510 PLATTE PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-6134
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	RYAN SPILLANE
Credential	:
Telephone Number	:	719-344-7135

Provider Enumeration Date	:	01/13/2010
Last Update Date	:	04/05/2023

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