1306104047 NPI number — PINNACLE HEALTH MANAGEMENT, LLC

Table of content: (NPI 1306104047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306104047 NPI number — PINNACLE HEALTH MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HEALTH MANAGEMENT, 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:
Provider Other Organization Name Type Code:
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:
1306104047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZARD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41702-0600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-435-7642
Provider Business Mailing Address Fax Number:
606-436-5282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21992 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
HYDEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41749-8567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-672-4800
Provider Business Practice Location Address Fax Number:
606-436-5282
Provider Enumeration Date:
05/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
606-439-1300

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 620662500 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100239760 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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