Healthcare Provider Details

I. General information

NPI: 1295543023
Provider Name (Legal Business Name): PINNACLE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 W I 44 SERVICE RD STE 200
OKLAHOMA CITY OK
73112-8766
US

IV. Provider business mailing address

236 NW 32ND ST
OKLAHOMA CITY OK
73118-8611
US

V. Phone/Fax

Practice location:
  • Phone: 405-759-0413
  • Fax:
Mailing address:
  • Phone: 405-759-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEDIDIAH PERDUE
Title or Position: PSYCHIATRIST, OWNER
Credential: MD
Phone: 405-759-0413