Provider Demographics
NPI:1023112117
Name:PEAK GASTROENTEROLOGY ASSOCIATES
Entity type:Organization
Organization Name:PEAK GASTROENTEROLOGY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-310-6731
Mailing Address - Street 1:2920 N CASCADE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6265
Mailing Address - Country:US
Mailing Address - Phone:719-636-1201
Mailing Address - Fax:719-955-0986
Practice Address - Street 1:2920 N CASCADE AVE STE 301
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6265
Practice Address - Country:US
Practice Address - Phone:719-636-1201
Practice Address - Fax:719-955-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32410207RG0100X
CO37170207RG0100X
CO39991207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04018834Medicaid
COPA648080OtherBCBS
COC418908Medicare PIN
COC418908Medicare PIN