| Peak Neurology Corp Pc | |
|
5770 Flintridge Dr Colorado Springs CO 80918-1881 | |
| (719) 445-9902 | |
| Not Available |
| Full Name | Peak Neurology Corp Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5770 Flintridge Dr, Colorado Springs, Colorado |
| Authorized Official Name and Position | Bradley Priebe (PHYSICIAN/CEO) |
| Authorized Official Contact | 7194459902 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peak Neurology Corp Pc 13010 Tahosa Ln Colorado Springs CO 80908-3251 Ph: (269) 209-7019 | Peak Neurology Corp Pc 5770 Flintridge Dr Colorado Springs CO 80918-1881 Ph: (719) 445-9902 |
| NPI Number | 1144763251 |
|---|---|
| Provider Enumeration Date | 11/21/2016 |
| Last Update Date | 03/01/2018 |
| Medicare PECOS PAC ID | 0042592339 |
|---|---|
| Medicare Enrollment ID | O20170121000086 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144763251 | NPI | - | NPPES |
| 9000149974 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | DR.0054025 (Colorado) | Secondary |
| Provider Name | William Tyler Stone |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1023322039 PECOS PAC ID: 4789879958 Enrollment ID: I20130917000191 |
| Provider Name | Bradley J Priebe |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1609195676 PECOS PAC ID: 0648498956 Enrollment ID: I20140828001533 |
| Provider Name | Lisa Marie Dudzik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700946720 PECOS PAC ID: 5597023713 Enrollment ID: I20171218000559 |
| Provider Name | Michele Ann Gatheridge |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1952543555 PECOS PAC ID: 6406107358 Enrollment ID: I20180917001161 |
| Provider Name | Erin L Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205473253 PECOS PAC ID: 0042636987 Enrollment ID: I20230801002531 |
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