Provider Demographics
NPI:1336594381
Name:PEEP CLINIC
Entity Type:Organization
Organization Name:PEEP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGARRY
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:720-771-1135
Mailing Address - Street 1:9249 S BROADWAY
Mailing Address - Street 2:#200-268
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-5690
Mailing Address - Country:US
Mailing Address - Phone:720-771-1135
Mailing Address - Fax:
Practice Address - Street 1:6179 S BALSAM WAY
Practice Address - Street 2:#205
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3091
Practice Address - Country:US
Practice Address - Phone:720-771-1135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992162-NP261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty