Provider Demographics
NPI:1508022070
Name:CHRISTINE HARTER MD PC
Entity Type:Organization
Organization Name:CHRISTINE HARTER MD PC
Other - Org Name:PINNACLE INTERNAL MEDICINE & HEADACHE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-748-8300
Mailing Address - Street 1:6320 W UNION HILLS DR STE A180
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7153
Mailing Address - Country:US
Mailing Address - Phone:623-748-8300
Mailing Address - Fax:623-748-8314
Practice Address - Street 1:6320 W UNION HILLS DR STE A180
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-748-8300
Practice Address - Fax:623-748-8314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29110207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ355399Medicaid
AZ355399Medicaid
AZZ125202Medicare PIN