Provider Demographics
NPI:1043404510
Name:PINNACLE MEDICAL GROUP
Entity Type:Organization
Organization Name:PINNACLE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOHREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-320-3999
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:STE 602
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-320-3999
Mailing Address - Fax:615-320-8877
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:STE 602
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-320-3999
Practice Address - Fax:615-320-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00464034OtherRAILROAD MEDICARE
TN1295770915OtherINDIVIDUAL NPI 1295770915
TN3731365Medicaid
TN4114884OtherBLUECROSS BLUE SHIELD
TN4114884OtherBLUECROSS BLUE SHIELD
H86977Medicare UPIN