Provider Demographics
NPI:1578660718
Name:PINNACLE MEDICAL GROUP ARIZONA, P.C.
Entity Type:Organization
Organization Name:PINNACLE MEDICAL GROUP ARIZONA, P.C.
Other - Org Name:PINNACLE HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-341-4544
Mailing Address - Street 1:4343 E 31ST PLACE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365
Mailing Address - Country:US
Mailing Address - Phone:928-341-4544
Mailing Address - Fax:928-341-4514
Practice Address - Street 1:4343 E 31ST PL
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365
Practice Address - Country:US
Practice Address - Phone:928-341-4544
Practice Address - Fax:928-341-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG78250Medicare UPIN