Provider Demographics
NPI:1316606619
Name:PEAK PERFORMANCE AGENCY LLC
Entity type:Organization
Organization Name:PEAK PERFORMANCE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASMYNE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MCENTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-463-9448
Mailing Address - Street 1:819 SEIGLE AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2094
Mailing Address - Country:US
Mailing Address - Phone:843-463-9948
Mailing Address - Fax:
Practice Address - Street 1:819 SEIGLE AVE APT 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2094
Practice Address - Country:US
Practice Address - Phone:843-463-9948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory