Provider Demographics
NPI:1942214259
Name:PEAK URGENT CARE
Entity Type:Organization
Organization Name:PEAK URGENT CARE
Other - Org Name:PEAK MEDICAL MEDICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKESTRAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-296-4277
Mailing Address - Street 1:PO BOX 12746
Mailing Address - Street 2:2101 N COUNTRY CLUB RD SUITE 105
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716
Mailing Address - Country:US
Mailing Address - Phone:520-296-4277
Mailing Address - Fax:520-296-4507
Practice Address - Street 1:2101 N COUNTRY CLUB RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716
Practice Address - Country:US
Practice Address - Phone:520-296-4277
Practice Address - Fax:520-296-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ494914Medicaid
AZZ79434Medicare ID - Type Unspecified
AZ494914Medicaid