1356904106 NPI number — PINNACLE HEALTH SERVICES

Table of content: (NPI 1356904106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356904106 NPI number — PINNACLE HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HEALTH SERVICES
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:
1356904106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
879 CARRIAGE RUN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30046-2414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-917-4346
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 S MILITARY RD STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOND DU LAC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54935-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-917-4346
Provider Business Practice Location Address Fax Number:
866-493-9554
Provider Enumeration Date:
04/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
LO
Authorized Official First Name:
KA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMIN
Authorized Official Telephone Number:
404-917-4346

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100076774 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com