Provider Demographics
NPI:1467649756
Name:MOUNTAIN PEAKS UROLOGY PC
Entity Type:Organization
Organization Name:MOUNTAIN PEAKS UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-275-2000
Mailing Address - Street 1:502 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3336
Mailing Address - Country:US
Mailing Address - Phone:719-275-2000
Mailing Address - Fax:719-275-3145
Practice Address - Street 1:502 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3336
Practice Address - Country:US
Practice Address - Phone:719-275-2000
Practice Address - Fax:719-275-3145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92677029Medicaid
CO92677029Medicaid