Provider Demographics
NPI:1235648775
Name:SUMMIT PEAK NUTRITION SERVICES LLC
Entity Type:Organization
Organization Name:SUMMIT PEAK NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:720-459-0913
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:CO
Mailing Address - Zip Code:80135-0732
Mailing Address - Country:US
Mailing Address - Phone:720-459-0913
Mailing Address - Fax:
Practice Address - Street 1:2505 BIG BEAR CIR
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:CO
Practice Address - Zip Code:80135-4433
Practice Address - Country:US
Practice Address - Phone:720-459-0913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty