Provider Demographics
NPI:1790159028
Name:PEAK FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:PEAK FAMILY MEDICINE LLC
Other - Org Name:PEAK DENTAL HYGIENE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ADRAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-497-4921
Mailing Address - Street 1:1550 EAST 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:855-855-4482
Practice Address - Street 1:1550 EAST 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:855-855-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty