Provider Demographics
NPI:1205051232
Name:PEAK VISTA COMMUNITY HEALTH CENTERS
Entity type:Organization
Organization Name:PEAK VISTA COMMUNITY HEALTH CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:NARVET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-344-6188
Mailing Address - Street 1:3205 N ACADMEY BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917
Mailing Address - Country:US
Mailing Address - Phone:719-632-5700
Mailing Address - Fax:719-344-7865
Practice Address - Street 1:155 PRINTERS PARKWAY
Practice Address - Street 2:SUITE 230
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910
Practice Address - Country:US
Practice Address - Phone:719-632-5700
Practice Address - Fax:719-633-5492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK VISTA COMMUNITY HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-16
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18812207Q00000X
CO261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000141901Medicaid
CO22238824Medicaid