Healthcare Provider Details

I. General information

NPI: 1922546530
Provider Name (Legal Business Name): PINNACLE HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 BROADWAY
MERRILLVILLE IN
46410-7173
US

IV. Provider business mailing address

9301 CONNECTICUT DR
CROWN POINT IN
46307-7486
US

V. Phone/Fax

Practice location:
  • Phone: 219-795-1890
  • Fax:
Mailing address:
  • Phone: 219-756-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. HAROON RASHID ANSARI
Title or Position: CEO
Credential:
Phone: 219-796-4103