1639162829 NPI number — PINNACLE DIALYSIS INC

Table of content: (NPI 1639162829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639162829 NPI number — PINNACLE DIALYSIS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE DIALYSIS INC
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:
6
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:
1639162829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 N MILITARY TRL
Provider Second Line Business Mailing Address:
#195
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431-6365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-241-6667
Provider Business Mailing Address Fax Number:
561-989-8550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 N MILITARY TRL
Provider Second Line Business Practice Location Address:
#195
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33431-6365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-241-6667
Provider Business Practice Location Address Fax Number:
561-989-8550
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STEMMER
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
561-241-6667

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890064700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: V4M . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com