Provider Demographics
NPI:1720738669
Name:PINNACLE HEALTH GROUP P.A.
Entity Type:Organization
Organization Name:PINNACLE HEALTH GROUP P.A.
Other - Org Name:PINNACLE HEALTH GROUP WESLEY CHAPEL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DIASTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-874-5500
Mailing Address - Street 1:PO BOX 18344
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-8344
Mailing Address - Country:US
Mailing Address - Phone:813-874-5500
Mailing Address - Fax:813-874-5505
Practice Address - Street 1:2590 HEALING WAY STE 110
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-5496
Practice Address - Country:US
Practice Address - Phone:813-874-5500
Practice Address - Fax:813-874-5505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE HEALTH GROUP P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-24
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME71925OtherMED LICENSE