Organization
MOUNTAIN PEAKS FAMILY PRACTICE PC
Active
Other names
Mountain Peaks Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN K WADE (OWNER)
(970) 216-6199
Entity
Organization
Contact information
Practice address
836 S TOWNSEND AVE STE A, MONTROSE, CO 81401-4360
(970) 615-9120
(970) 240-1139
Mailing address
836 S TOWNSEND AVE STE A, MONTROSE, CO 81401-4360
(970) 615-9120
(970) 240-1139
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50825330
—
CO
01
—
622111300
DEPT OF LABOR: FECA, BLACK LUNG, ENERGY
—
01
—
DW8070
RAILROAD WORKERS MEDICARE PTAN
—
Enumeration date
05/25/2016
Last updated
10/24/2016
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