1851488928 NPI number — PINNACLE HEALTH FACILITIES XV LP

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 1851488928 NPI number — PINNACLE HEALTH FACILITIES XV LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HEALTH FACILITIES XV LP
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:
1851488928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5420 W PLANO PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-4823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-931-3800
Provider Business Mailing Address Fax Number:
972-976-6222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1661 W YOAKUM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARANSAS PASS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78336-4431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-758-7686
Provider Business Practice Location Address Fax Number:
361-758-3545
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLLIER
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
LATTURE
Authorized Official Title or Position:
DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
972-931-3800

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001014603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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