Healthcare Provider Details

I. General information

NPI: 1144313669
Provider Name (Legal Business Name): PINNACLE ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N HOSPITAL DRIVE
PRICE UT
84501
US

IV. Provider business mailing address

PO BOX 3750
SALT LAKE CITY UT
84110-3750
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-4800
  • Fax: 801-432-2670
Mailing address:
  • Phone: 888-304-6796
  • Fax: 801-432-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TODD WILLIAM JOHNSON
Title or Position: PRESIDENT
Credential: MD
Phone: 888-304-6796