Healthcare Provider Details

I. General information

NPI: 1780160366
Provider Name (Legal Business Name): PINNACLE REGIONAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17651 B HWY
BOONVILLE MO
65233-2839
US

IV. Provider business mailing address

4770 N BELLEVIEW AVE STE 205
KANSAS CITY MO
64116-2119
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-7461
  • Fax: 660-882-6093
Mailing address:
  • Phone: 816-809-8365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number248-47
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number248-47
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number248-47
License Number StateMO

VIII. Authorized Official

Name: JENNIFER SKANES
Title or Position: CREDENTIALING CONTACT
Credential:
Phone: 660-882-7461