Provider Demographics
NPI:1518353374
Name:PINNACLE MEDICAL PARTNERS LLC
Entity Type:Organization
Organization Name:PINNACLE MEDICAL PARTNERS LLC
Other - Org Name:LONE TREE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEPHTALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-613-4441
Mailing Address - Street 1:10103 RIDGEGATE PKWY
Mailing Address - Street 2:SUITE 221
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5520
Mailing Address - Country:US
Mailing Address - Phone:303-803-1005
Mailing Address - Fax:303-798-3248
Practice Address - Street 1:10103 RIDGEGATE PKWY
Practice Address - Street 2:SUITE 221
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5520
Practice Address - Country:US
Practice Address - Phone:303-803-1005
Practice Address - Fax:303-798-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36496208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty