Provider Demographics
NPI:1689098410
Name:PINNACLE PHYSICIANS GROUP, LLC
Entity Type:Organization
Organization Name:PINNACLE PHYSICIANS GROUP, LLC
Other - Org Name:PINNACLE CLINICAL PAIN MANAGEMENT ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-435-1709
Mailing Address - Street 1:3110 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2542
Mailing Address - Country:US
Mailing Address - Phone:215-464-6600
Mailing Address - Fax:215-464-2378
Practice Address - Street 1:3110 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2542
Practice Address - Country:US
Practice Address - Phone:215-464-6600
Practice Address - Fax:215-464-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty