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)

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

General Provider Information

NPI Number	:	1912515735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK VISTA COMMUNITY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	3205 N ACADEMY BLVD STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5152
Country	:	US
Telephone Number	:	719-631-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 E CUCHARRAS ST STE 2
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3609
Country	:	US
Telephone Number	:	559-632-5700
Fax Number	:

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

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	03/06/2023

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