Provider Demographics
NPI:1407623218
Name:PEAKMED COLORADO, LLC
Entity Type:Organization
Organization Name:PEAKMED COLORADO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:VIKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-814-0927
Mailing Address - Street 1:6945 TUTT BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3566
Mailing Address - Country:US
Mailing Address - Phone:844-673-2563
Mailing Address - Fax:
Practice Address - Street 1:13271 BASS PRO DR STE 140
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3828
Practice Address - Country:US
Practice Address - Phone:719-394-8664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty