Provider Demographics
NPI:1801113147
Name:PEAK HEALTHCARE, INC
Entity type:Organization
Organization Name:PEAK HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:435-637-2324
Mailing Address - Street 1:894 E 100 N
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2711
Mailing Address - Country:US
Mailing Address - Phone:435-637-2324
Mailing Address - Fax:435-637-2326
Practice Address - Street 1:894 E 100 N
Practice Address - Street 2:SUITE 3
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2711
Practice Address - Country:US
Practice Address - Phone:435-637-2324
Practice Address - Fax:435-637-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363AM0700X261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00228226OtherRAILROAD MEDICARE
UT005751001OtherMEDICARE ID - TYPE UNSPECIFIED
UTP00228226OtherRAILROAD MEDICARE