Provider Demographics
NPI:1932250693
Name:PEAK PERFORMANCE INTEGRATED MEDICINE, PLC
Entity type:Organization
Organization Name:PEAK PERFORMANCE INTEGRATED MEDICINE, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-447-8888
Mailing Address - Street 1:4150 E BELTLINE AVE NE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9316
Mailing Address - Country:US
Mailing Address - Phone:616-447-9888
Mailing Address - Fax:616-447-9886
Practice Address - Street 1:4150 E BELTLINE AVE NE
Practice Address - Street 2:SUITE #3
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9316
Practice Address - Country:US
Practice Address - Phone:616-447-9888
Practice Address - Fax:616-447-9886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P39340Medicare PIN