Provider Demographics
NPI:1689437436
Name:PETER IVEY LLC
Entity Type:Organization
Organization Name:PETER IVEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-277-3607
Mailing Address - Street 1:511 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4914
Mailing Address - Country:US
Mailing Address - Phone:530-277-3607
Mailing Address - Fax:
Practice Address - Street 1:555 CORPORATE DR STE 204
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6138
Practice Address - Country:US
Practice Address - Phone:530-277-3607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental