HEALTH CENTER AT FOUNTAIN – NPI #1124320106
Clinic/Center

HEALTH CENTER AT FOUNTAIN is an AHC clinic located in FOUNTAIN, CO. NPPES has assigned the NPI number 1124320106 to HEALTH CENTER AT FOUNTAIN on November 24, 2010. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “HEALTH CENTER AT FOUNTAIN” is a dba name, the actual legal business name for this organization is PEAK VISTA COMMUNITY HEALTH CENTERS. The primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC)

The NPI profile was previously updated about 3 years ago on Mar 06, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for HEALTH CENTER AT FOUNTAIN below.

NPI Profile for
PEAK VISTA COMMUNITY HEALTH CENTERS

NPI Number
1124320106
Enumeration Date

(more than 15 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing Business As (dba): HEALTH CENTER AT FOUNTAIN
Primary location
350 LYCKMAN DRIVE
FOUNTAIN, CO 80817
Phone: (719) 632-5700 Fax: (719) 322-0776
Mailing address
3205 N ACADEMY BLVD
SUITE 130
COLORADO SPRINGS, CO 80917
Phone: (719) 632-5700 Fax: (719) 344-7865
Organization Subpart
Yes - HEALTH CENTER AT FOUNTAIN is subpart of another organization.
Authorized Official
RYAN SPILLANE
CHIEF FINANCIAL OFFICER
Phone: (719) 344-7135
Updated
Certification Date
Mar 06, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for HEALTH CENTER AT FOUNTAIN

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidCO05638267
medicaidCO90158229
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QF0400X
- Clinic/Center / Federally Qualified Health Center (FQHC) (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.