1598959934 NPI number — PINNACLE HEALTH SERVICES OF NORTH CAROLINA, LLC

Table of content: (NPI 1598959934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598959934 NPI number — PINNACLE HEALTH SERVICES OF NORTH CAROLINA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HEALTH SERVICES OF NORTH CAROLINA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARDINAL POINTS IMAGING OF THE CAROLINAS, WAKE FOREST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598959934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CRESCENT CENTRE DR STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-7270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-261-2306
Provider Business Mailing Address Fax Number:
855-588-3545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
839 DURHAM RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WAKE FOREST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27587-8793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-532-3430
Provider Business Practice Location Address Fax Number:
919-877-5480
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
PERRY
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
615-550-6049

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001462197 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5913216 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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