Provider Demographics
NPI:1295925014
Name:PEAK ORTHOPEDICS AND SPORTS MEDICINE PLLC
Entity type:Organization
Organization Name:PEAK ORTHOPEDICS AND SPORTS MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOBBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-863-9340
Mailing Address - Street 1:PO BOX 2053
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2908
Mailing Address - Country:US
Mailing Address - Phone:406-863-9340
Mailing Address - Fax:406-863-9342
Practice Address - Street 1:1111 BAKER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2908
Practice Address - Country:US
Practice Address - Phone:406-863-9340
Practice Address - Fax:406-863-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTDC6415Medicare PIN