Provider Demographics
NPI:1598091308
Name:PINNACLE SPORTS MEDICINE & ORTHOPAEDICS, PA
Entity Type:Organization
Organization Name:PINNACLE SPORTS MEDICINE & ORTHOPAEDICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-663-4800
Mailing Address - Street 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:STE. 240
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-7808
Mailing Address - Country:US
Mailing Address - Phone:316-283-9977
Mailing Address - Fax:316-283-0966
Practice Address - Street 1:1818 E 23RD AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1106
Practice Address - Country:US
Practice Address - Phone:620-662-6000
Practice Address - Fax:620-669-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110633OtherBCBS
KS100644510AMedicaid
KS4705300001OtherDMERC
KS4705300001OtherDMERC