Basic Information
| Provider Information | |||||||||
| NPI: | 1225689631 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEAK SURGICAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 W DRY CREEK CIR STE 120 | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801208078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205013909 | ||||||||
| FaxNumber: | 7205013916 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 W DRY CREEK CIR STE 120 | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801208078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205013909 | ||||||||
| FaxNumber: | 7205013916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2019 | ||||||||
| LastUpdateDate: | 12/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | GESQUIERE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3038298796 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207XX0005X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.