Healthcare Provider Details

I. General information

NPI: 1528337961
Provider Name (Legal Business Name): PINNACLE ANESTHESIA CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W HARWOOD RD SUITE 103
HURST TX
76054-3289
US

IV. Provider business mailing address

PO BOX 650866
DALLAS TX
75265-0866
US

V. Phone/Fax

Practice location:
  • Phone: 817-479-1500
  • Fax:
Mailing address:
  • Phone: 972-715-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND ROMO
Title or Position: DIRECTOR OF PROVIDER SERVICES
Credential:
Phone: 972-715-5000