Provider Demographics
NPI:1629516901
Name:PEAKS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PEAKS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:831-588-7296
Mailing Address - Street 1:320 RIVER PARK DR STE 125
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6065
Mailing Address - Country:US
Mailing Address - Phone:831-588-7296
Mailing Address - Fax:
Practice Address - Street 1:320 RIVER PARK DR STE 125
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6065
Practice Address - Country:US
Practice Address - Phone:831-588-7296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical