Provider Demographics
NPI:1609117795
Name:PINNACLE PHYSICIANS GROUP, LLC
Entity Type:Organization
Organization Name:PINNACLE PHYSICIANS GROUP, LLC
Other - Org Name:STREET ROAD MEDICAL ASSOCIATES, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-464-4111
Mailing Address - Street 1:339 E STREET RD
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7711
Mailing Address - Country:US
Mailing Address - Phone:215-464-4111
Mailing Address - Fax:
Practice Address - Street 1:2938 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3529
Practice Address - Country:US
Practice Address - Phone:215-639-1460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA248882Medicare PIN