Provider Demographics
NPI:1891825535
Name:PINNACLE HEALTH CONCEPTS, LLC
Entity Type:Organization
Organization Name:PINNACLE HEALTH CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-480-9362
Mailing Address - Street 1:755 BOARDMAN CANFIELD RD
Mailing Address - Street 2:BLDG F, UNIT 2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4300
Mailing Address - Country:US
Mailing Address - Phone:330-480-9362
Mailing Address - Fax:330-480-9407
Practice Address - Street 1:755 BOARDMAN CANFIELD RD
Practice Address - Street 2:BLDG F, UNIT 2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4300
Practice Address - Country:US
Practice Address - Phone:330-480-9362
Practice Address - Fax:330-480-9407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2384647Medicaid
OH9336281OtherMEDICARE