Peak Medical Gallup, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1040 Issued in NM

Legal business name

PEAK MEDICAL GALLUP, LLC

Practice address

306 E Nizhoni Blvd
Gallup, NM 87301-5794

Phone

(505) 863-9551

NPI assigned

May 23, 2006

Organization subpart

Yes

Parent organization

PEAK MEDICAL, LLCAs reported in NPPES

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

Authorized official

Name

Michael Berg

Title

Assistant Secretary

Phone

(505) 468-4752

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• McKinley 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

Locations

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489708800000",
    "number": "1699720227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 E NIZHONI BLVD",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015794",
            "telephone_number": "505-863-9551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 E NIZHONI BLVD",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015794",
            "telephone_number": "505-863-9551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK MEDICAL GALLUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEAK MEDICAL, LLC",
        "enumeration_date": "2006-05-23",
        "last_updated": "2017-03-17",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NM",
            "license": "1040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81629800",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McKinley Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Casey Patton, RN
• Justin R Paul, RN
• Nicole Aline Pavy, RN
• Jason Frank Pawlowski
• Jean Payton
• William Clay Pearson, M.S.
• Viola R Peina
• Regine Francine Penda Ewanga
• Alicia Marie Pender, RN
• Melissa Penn, CNM

• Skilled Nursing Facility in Gallup, NM
• Providers in Gallup, NM by specialty
• Skilled Nursing Facility in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2017; 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.