Provider Demographics
NPI:1972843910
Name:PINNACLE SURGICAL GROUP, PLLC
Entity Type:Organization
Organization Name:PINNACLE SURGICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHO
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:TAPAZOGLOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-282-7414
Mailing Address - Street 1:2235 CEDAR LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5202
Mailing Address - Country:US
Mailing Address - Phone:703-778-6000
Mailing Address - Fax:703-778-6005
Practice Address - Street 1:2235 CEDAR LN
Practice Address - Street 2:SUITE 101
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-5202
Practice Address - Country:US
Practice Address - Phone:703-778-6000
Practice Address - Fax:703-778-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251675261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101251675OtherLICENSE