Provider Demographics
NPI:1487608949
Name:PEAKS AND PLAINS MEDICAL, INC.
Entity type:Organization
Organization Name:PEAKS AND PLAINS MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AFRASIABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-441-1312
Mailing Address - Street 1:PO BOX 94347
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6647
Mailing Address - Country:US
Mailing Address - Phone:509-588-7241
Mailing Address - Fax:866-583-9296
Practice Address - Street 1:13524 E SPRAGUE AVE STE 2
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0888
Practice Address - Country:US
Practice Address - Phone:509-927-0991
Practice Address - Fax:866-583-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1011466Medicaid
ID1487608949Medicaid
MT1487608949Medicaid
MT0560150Medicaid
WA1169520001Medicare NSC