Provider Demographics
NPI:1881084838
Name:PINNACLE WOMEN'S CENTER LLC
Entity type:Organization
Organization Name:PINNACLE WOMEN'S CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-626-5453
Mailing Address - Street 1:PO BOX 10967
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-0967
Mailing Address - Country:US
Mailing Address - Phone:602-595-9696
Mailing Address - Fax:623-412-9123
Practice Address - Street 1:15396 N 83RD AVE STE F100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:602-595-9696
Practice Address - Fax:623-412-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005718207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1043422777OtherINDIVIDUAL NPI
AZ1144289232OtherINDIVIDUAL NPI
AZ578635Medicaid
AZ632408Medicaid