Provider Demographics
NPI:1962678706
Name:PINNACLE SERVICES NORTHWEST CORPORATION
Entity Type:Organization
Organization Name:PINNACLE SERVICES NORTHWEST CORPORATION
Other - Org Name:PEOPLES INJURY NETWORK NORTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-522-2026
Mailing Address - Street 1:20640 84TH AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1224
Mailing Address - Country:US
Mailing Address - Phone:253-395-1131
Mailing Address - Fax:253-395-1171
Practice Address - Street 1:20640 84TH AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1224
Practice Address - Country:US
Practice Address - Phone:253-395-1131
Practice Address - Fax:253-395-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7681786Medicaid