Provider Demographics
NPI:1588631121
Name:PEACH VALLEY FAMILY MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:PEACH VALLEY FAMILY MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOISINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-434-6542
Mailing Address - Street 1:3225 I-70 BUSINESS LOOP STE A4
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-7687
Mailing Address - Country:US
Mailing Address - Phone:970-434-6542
Mailing Address - Fax:970-434-3327
Practice Address - Street 1:3225 I-70 BUSINESS LOOP STE A4
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:CO
Practice Address - Zip Code:81520-7687
Practice Address - Country:US
Practice Address - Phone:970-434-6542
Practice Address - Fax:970-434-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52359OtherBCBS
CO94550581Medicaid
CO214-1043OtherAETNA
CO94550581Medicaid
CO=========001OtherRMHP