Provider Demographics
NPI:1619656139
Name:PINNACLE MEDICAL GROUP, HICKS PC
Entity Type:Organization
Organization Name:PINNACLE MEDICAL GROUP, HICKS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELVIRA
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-848-5125
Mailing Address - Street 1:5975 S LOS ALTOS PKWY STE 9
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-7699
Mailing Address - Country:US
Mailing Address - Phone:775-204-4000
Mailing Address - Fax:
Practice Address - Street 1:5990 SILVER LAKE RD STE C
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-2300
Practice Address - Country:US
Practice Address - Phone:775-972-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty