Organization Name: | PEAK VISTA COMMUNITY HEALTH CENTERS |
NPI Number: | 1124320106 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRADACH FITZWATER (VICE PRESIDENT OF FINANCE) |
Mailing Address: | 301 E Iowa Ave Fountain |
State: | CO US |
Postal Code: | 808172290 |
Phone Number: | 7193220777 |
Fax Number: | 7193220776 |
NPI Enumeration Date: | 11/24/2010 |
NPI Last Update Date: | 03/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |