Provider Demographics
NPI:1093590341
Name:PINNACLE FAMILY MEDICINE PLC
Entity Type:Organization
Organization Name:PINNACLE FAMILY MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-935-9600
Mailing Address - Street 1:21753 N 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2110
Mailing Address - Country:US
Mailing Address - Phone:623-935-9600
Mailing Address - Fax:623-935-9602
Practice Address - Street 1:21753 N 77TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2110
Practice Address - Country:US
Practice Address - Phone:623-935-9600
Practice Address - Fax:623-935-9602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE FAMILY MEDICINE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty