Healthcare Provider Details

I. General information

NPI: 1104315647
Provider Name (Legal Business Name): PINNACLE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3172 N. RAINBOW BLVD SUITE# 1176
LAS VEGAS NV
89108
US

IV. Provider business mailing address

3172 N. RAINBOW BLVD SUITE# 1176
LAS VEGAS NV
89108
US

V. Phone/Fax

Practice location:
  • Phone: 775-553-8257
  • Fax: 702-973-3477
Mailing address:
  • Phone: 775-553-8257
  • Fax: 702-973-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TENESHIA DACHELL SPENCER
Title or Position: CEO
Credential:
Phone: 702-664-1690