Provider Demographics
NPI:1578095832
Name:PEAK AFTER HOURS LLC
Entity Type:Organization
Organization Name:PEAK AFTER HOURS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ADRAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-497-4921
Mailing Address - Street 1:1550 NIAGARA RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5027
Mailing Address - Country:US
Mailing Address - Phone:970-497-4921
Mailing Address - Fax:
Practice Address - Street 1:1550 NIAGARA RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5027
Practice Address - Country:US
Practice Address - Phone:970-497-4921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCAPN0000451CNP261QP2300X
COPA.0003531261QP2300X
COPA.0004519261QP2300X
CODR.0052752261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85681369Medicaid
CO13830074Medicaid
CO63020254Medicaid
AB-45685Medicare UPIN
CO85681369Medicaid
418495Medicare PIN
497750ZPR5Medicare PIN
CO13830074Medicaid