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Organization

PEAK MEDICAL OF IDAHO LLC

Active
Parent organization
PEAK MEDICAL LLC
Other names
Twin Falls Center
Organization subpart
Yes

Provider details

NPI number
Legal business name
PEAK MEDICAL LLC
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization

Contact information

Practice address
674 EASTLAND DR, TWIN FALLS, ID 83301-6846
(208) 734-4264
(208) 734-0647
Mailing address
674 EASTLAND DR, TWIN FALLS, ID 83301-6846
(208) 734-4264
(208) 734-0647

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
51
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010013150
BLUE SHIELD OF IDAHO
ID
01
01057
BLUE CROSS
ID
05
805152400
ID
Enumeration date
05/19/2006
Last updated
03/31/2016
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