1487329371 NPI number — PINNACLE HEALTHCARE ASSOCIATES OF TEXAS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487329371 NPI number — PINNACLE HEALTHCARE ASSOCIATES OF TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HEALTHCARE ASSOCIATES OF TEXAS
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:
1487329371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 192554
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75219-8522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-756-4832
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 MARKET PLACE BLVD STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-599-5888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
ROY
Authorized Official First Name:
DEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
209-756-4832

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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