Healthcare Provider Details

I. General information

NPI: 1043493851
Provider Name (Legal Business Name): PINNACLE MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 HIGHWAY 570
SUMMIT MS
39666-7563
US

IV. Provider business mailing address

7900 HIGHWAY 570
SUMMIT MS
39666-7563
US

V. Phone/Fax

Practice location:
  • Phone: 601-684-7771
  • Fax: 601-684-1616
Mailing address:
  • Phone: 601-684-7771
  • Fax: 601-684-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number14467
License Number StateMS

VIII. Authorized Official

Name: DR. DAVID P SMITH
Title or Position: CEO
Credential: MD, FAAFP
Phone: 601-684-7771