Provider Demographics
NPI:1639162829
Name:PINNACLE DIALYSIS INC
Entity Type:Organization
Organization Name:PINNACLE DIALYSIS INC
Other - Org Name:DIALYSIS OF BOCA DELRAY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-241-6667
Mailing Address - Street 1:2900 N MILITARY TRL
Mailing Address - Street 2:#195
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6365
Mailing Address - Country:US
Mailing Address - Phone:561-241-6667
Mailing Address - Fax:561-989-8550
Practice Address - Street 1:2900 N MILITARY TRL
Practice Address - Street 2:#195
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6365
Practice Address - Country:US
Practice Address - Phone:561-241-6667
Practice Address - Fax:561-989-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890064700Medicaid
FLV4MOtherBCBS
102658Medicare Oscar/Certification