Provider Demographics
NPI:1831347095
Name:PINNACLE SURGICAL GROUP, PC
Entity type:Organization
Organization Name:PINNACLE SURGICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-460-2055
Mailing Address - Street 1:2710 HARNEY ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2884
Mailing Address - Country:US
Mailing Address - Phone:307-460-2055
Mailing Address - Fax:307-460-2058
Practice Address - Street 1:2710 HARNEY ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2884
Practice Address - Country:US
Practice Address - Phone:307-460-2055
Practice Address - Fax:307-460-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1040 (TEMPORARY)208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty