Peak Medical of Boise, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PEAK MEDICAL OF BOISE, LLC

Practice address

1220 Montana Street
Gooding, ID 83330-1856

Phone

(208) 934-5601

Fax

(208) 934-8154

NPI assigned

Jun 7, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael T. Berg

Title

Assistant Secretary

Phone

(505) 468-4752

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bennett Hills Center Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Sunbridge Healthcare LLC

  • Skilled Nursing Facility
  • Tuscumbia, AL
  • NPI 1285685362

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463356800000",
    "number": "1013237528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 MONTANA STREET",
            "city": "GOODING",
            "state": "ID",
            "postal_code": "833301856",
            "telephone_number": "208-934-5601",
            "fax_number": "208-934-8154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 MONTANA STREET",
            "city": "GOODING",
            "state": "ID",
            "postal_code": "833301856",
            "telephone_number": "208-934-5601",
            "fax_number": "208-934-8154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK MEDICAL OF BOISE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-07",
        "last_updated": "2016-05-16",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8085076",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bennett Hills Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Marie Olsen, D.O.
• Erin Orloff
• Susan A. Ormond, RD, LD, CDE
• Anna Delaney Owen
• Sierra Ann Oyler, PA-C
• Ty Peterson, DMD
• Karen Lee Petty
• Christina Ann Pickett, RDN, LD
• Pro Active Advantage, LLC
• Pro Active Advantage, LLC

• Skilled Nursing Facility in Gooding, ID
• Providers in Gooding, ID by specialty
• Skilled Nursing Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.