Provider Demographics
NPI:1346998283
Name:HORIZON PEAKS FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:HORIZON PEAKS FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:MILLER HEERY
Authorized Official - Suffix:
Authorized Official - Credentials:DRNP, FNP, BC
Authorized Official - Phone:610-533-8115
Mailing Address - Street 1:PO BOX 31609
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80931-1609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 PRINTERS PKWY STE 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3109
Practice Address - Country:US
Practice Address - Phone:610-533-8115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP52403Medicaid