Provider Demographics
NPI:1679663140
Name:PINNACLE HEALTHCARE OF OKLAHOMA LLP
Entity Type:Organization
Organization Name:PINNACLE HEALTHCARE OF OKLAHOMA LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:918-331-1653
Mailing Address - Street 1:4140 ADAMS RD.
Mailing Address - Street 2:#102
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006
Mailing Address - Country:US
Mailing Address - Phone:918-331-1653
Mailing Address - Fax:918-331-1645
Practice Address - Street 1:10512 N 110TH EAST AVE.
Practice Address - Street 2:STE. 220
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055
Practice Address - Country:US
Practice Address - Phone:918-609-7900
Practice Address - Fax:918-609-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
OK21533207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6253380001Medicare NSC