MEDICARE: PINNACLE GENETICS LABS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548837149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE GENETICS LABS INC

Provider Business Mailing Address
First Line	:	20185 NE 16TH PL UNIT A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-2720
Country	:	US
Telephone Number	:	305-931-1557
Fax Number	:

Provider Business Practice Location Address
First Line	:	20185 NE 16TH PL UNIT A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-2720
Country	:	US
Telephone Number	:	305-931-1557
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, OWNER
Name	:	RON OHANA
Credential	:	PRESIDENT
Telephone Number	:	786-554-4441

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	06/10/2021

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