Provider Demographics
NPI:1578865028
Name:PEAK PROVIDER SERVICES, INC
Entity Type:Organization
Organization Name:PEAK PROVIDER SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KOCINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-505-0459
Mailing Address - Street 1:PO BOX 3970
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34692-0970
Mailing Address - Country:US
Mailing Address - Phone:727-505-0459
Mailing Address - Fax:727-857-3381
Practice Address - Street 1:2435 US HIGHWAY 19
Practice Address - Street 2:SUITE 540
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3903
Practice Address - Country:US
Practice Address - Phone:727-505-0459
Practice Address - Fax:727-940-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686781201Medicaid
FL686781296Medicaid