06D2132839 CLIA NUMBER - PEAK FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 06D2132839

Facility Name: PEAK FAMILY PRACTICE

Facility Address:
1304 NORTH ACADEMY BLVD SUITE 201
COLORADO SPRINGS, CO
ZIP 80909
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Facility Phone Number: 719 465-2388

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1932505146

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	06D2132839
LAB Type	Practitioner Other
Facility Name	PEAK FAMILY PRACTICE
Street	1304 NORTH ACADEMY BLVD SUITE 201
City	COLORADO SPRINGS
State	CO
ZIP	80909
Phone	719 465-2388
CertificateType	4
CertificateEffectiveDate	6/28/2023
CertificateExpirationDate	6/27/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024