1649271552 NPI number — PINNACLE HEALTH CARE LLC

Table of content: (NPI 1649271552)

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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