Provider Demographics
NPI:1528002219
Name:PINNACLE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:PINNACLE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-979-1717
Mailing Address - Street 1:6790 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5023
Mailing Address - Country:US
Mailing Address - Phone:623-979-1717
Mailing Address - Fax:623-979-1707
Practice Address - Street 1:6790 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5023
Practice Address - Country:US
Practice Address - Phone:623-979-1717
Practice Address - Fax:623-979-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
AZOSC4105261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ111493Medicare PIN
AZ1528002219Medicare UPIN