1013588581 NPI number — PINNACLE MEDICAL SUPPLIES LLC

Table of content: (NPI 1013588581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013588581 NPI number — PINNACLE MEDICAL SUPPLIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE MEDICAL SUPPLIES 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:
1013588581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14261 E 4TH AVE STE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80011-8463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-532-8130
Provider Business Mailing Address Fax Number:
866-410-3231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14261 E 4TH AVE STE 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80011-8463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-532-8130
Provider Business Practice Location Address Fax Number:
720-328-8010
Provider Enumeration Date:
07/07/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
MAOBUGHICHI
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
303-435-9697

Provider Taxonomy Codes

  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20211626695 . This is a "COLORADO SECRETARY OF STATE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 9000206221 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".