Healthcare Provider Details

I. General information

NPI: 1447060868
Provider Name (Legal Business Name): PINNACLE PEDIATRICS AND INTERNAL MEDICINE PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S ONEIDA ST STE 248
DENVER CO
80224-2551
US

IV. Provider business mailing address

1776 CURTIS ST STE 130
DENVER CO
80202-2541
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-0600
  • Fax: 303-504-0601
Mailing address:
  • Phone: 720-239-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WALTER WILSON
Title or Position: OWNER
Credential:
Phone: 720-223-6177