Provider Demographics
NPI:1316601156
Name:PEAK FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:PEAK FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-643-4231
Mailing Address - Street 1:1495 PARKWAY DR STE C
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1639
Mailing Address - Country:US
Mailing Address - Phone:208-643-4231
Mailing Address - Fax:208-643-4235
Practice Address - Street 1:1495 PARKWAY DR STE C
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1639
Practice Address - Country:US
Practice Address - Phone:208-643-4231
Practice Address - Fax:208-643-4235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty