Provider Demographics
NPI:1033824230
Name:PINNACLE GASTROENTEROLOGY LLC
Entity Type:Organization
Organization Name:PINNACLE GASTROENTEROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-430-5995
Mailing Address - Street 1:2076 CIELO BONITO
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-7873
Mailing Address - Country:US
Mailing Address - Phone:203-430-5995
Mailing Address - Fax:
Practice Address - Street 1:700 CUBA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5951
Practice Address - Country:US
Practice Address - Phone:575-201-3280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2020-0321OtherNEW MEXICO PHYSICIAN/ MEDICAL LICENSE