Provider Demographics
NPI:1891843967
Name:PINNACLE MEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:PINNACLE MEDICAL CLINIC, P.A.
Other - Org Name:PINNACLE MEDICAL CLINIC,P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNYFFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-409-3000
Mailing Address - Street 1:2401 TUCKASEEGEE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208
Mailing Address - Country:US
Mailing Address - Phone:704-409-3000
Mailing Address - Fax:704-409-2382
Practice Address - Street 1:2401 TUCKASEEGEE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4058
Practice Address - Country:US
Practice Address - Phone:704-409-3000
Practice Address - Fax:704-409-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016R2Medicaid
NC89016R2Medicaid
NCF77517Medicare UPIN