Healthcare Provider Details

I. General information

NPI: 1093590341
Provider Name (Legal Business Name): PINNACLE FAMILY MEDICINE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21753 N 77TH AVE
PEORIA AZ
85382-2110
US

IV. Provider business mailing address

21753 N 77TH AVE
PEORIA AZ
85382-2110
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-9600
  • Fax: 623-935-9602
Mailing address:
  • Phone: 623-935-9600
  • Fax: 623-935-9602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STACEY ENGSTROM
Title or Position: PRACTICE MANAGER
Credential:
Phone: 623-935-9600