Provider Demographics
NPI:1336807486
Name:PEAK MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:PEAK MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARISE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:ATTORNEY
Authorized Official - Phone:907-252-6357
Mailing Address - Street 1:1486 E SKYLINE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4863
Mailing Address - Country:US
Mailing Address - Phone:801-436-5937
Mailing Address - Fax:801-610-7823
Practice Address - Street 1:1486 E SKYLINE DR STE 200
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4863
Practice Address - Country:US
Practice Address - Phone:801-436-5937
Practice Address - Fax:801-610-7823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty