Provider Demographics
NPI:1851686166
Name:PEAK SPECIALTY GROUP
Entity Type:Organization
Organization Name:PEAK SPECIALTY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-904-2340
Mailing Address - Street 1:1220 E 3900 S STE 4D
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1383
Mailing Address - Country:US
Mailing Address - Phone:801-904-2340
Mailing Address - Fax:
Practice Address - Street 1:1220 E 3900 S STE 4D
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1383
Practice Address - Country:US
Practice Address - Phone:801-904-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1851686166Medicaid
UT467332Medicare Oscar/Certification