Provider Demographics
NPI:1609876556
Name:PEAK ONE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:PEAK ONE SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, BOARD OF MANAGERS
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:JANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-668-1458
Mailing Address - Street 1:PO BOX 5541
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5541
Mailing Address - Country:US
Mailing Address - Phone:970-668-1458
Mailing Address - Fax:970-668-1703
Practice Address - Street 1:350 PEAK ONE DRIVE
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-1458
Practice Address - Fax:970-668-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0173261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804707Medicare PIN