Provider Demographics
NPI:1902239221
Name:SPANISH PEAKS HEALTHCARE SYSTEMS
Entity Type:Organization
Organization Name:SPANISH PEAKS HEALTHCARE SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-545-2746
Mailing Address - Street 1:1026 W ABRIENDO AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1128
Mailing Address - Country:US
Mailing Address - Phone:719-545-2746
Mailing Address - Fax:719-545-4100
Practice Address - Street 1:1026 W ABRIENDO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1128
Practice Address - Country:US
Practice Address - Phone:719-545-2746
Practice Address - Fax:719-545-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-11
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service