1649271552 NPI number — PINNACLE HEALTH CARE LLC

Table of content: PRABHJOT KAUR GREWAL MD (NPI 1134705643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649271552 NPI number — PINNACLE HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HEALTH CARE 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:
1649271552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1460 N 16TH AVE
Provider Second Line Business Mailing Address:
STE. B
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98902-7102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-248-0497
Provider Business Mailing Address Fax Number:
509-248-4167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1460 N 16TH AVE
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-7102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-0497
Provider Business Practice Location Address Fax Number:
509-248-4167
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DESHPANDE
Authorized Official First Name:
ABHIJIT
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-248-0497

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1200X , with the licence number: MD00033867 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7127699 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9056631 . This is a "DME SUPPLIER FOR DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1116938 . This is a "DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 607333500 . This is a "OFFICE OF WORKERS COMP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00217647 . This is a "MEDICARE RAILROAD NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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