Provider Demographics
NPI:1831236421
Name:PINNACLE PEAK NEUROLOGY, LLC
Entity type:Organization
Organization Name:PINNACLE PEAK NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-650-2944
Mailing Address - Street 1:PO BOX 26416
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0123
Mailing Address - Country:US
Mailing Address - Phone:480-650-2944
Mailing Address - Fax:480-634-1436
Practice Address - Street 1:9817 N 95TH ST
Practice Address - Street 2:STE 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4587
Practice Address - Country:US
Practice Address - Phone:480-650-2944
Practice Address - Fax:480-634-1436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ108336Medicare ID - Type UnspecifiedGROUP NUMBER