Provider Demographics
NPI:1477062677
Name:PINNACLE PAIN & SPINE CONSULTANTS, PLC
Entity Type:Organization
Organization Name:PINNACLE PAIN & SPINE CONSULTANTS, PLC
Other - Org Name:PINNACLE PAIN & SPINE CONSULTANTS, PLC-DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-407-6400
Mailing Address - Street 1:17505 N 79TH AVE STE 304A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8729
Mailing Address - Country:US
Mailing Address - Phone:480-407-6402
Mailing Address - Fax:623-777-7169
Practice Address - Street 1:9023 E DESERT COVE AVE STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6779
Practice Address - Country:US
Practice Address - Phone:480-407-6400
Practice Address - Fax:480-407-6520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE PAIN & SPINE CONSULTANTS, PLC-DME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42847332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ287745Medicaid