Healthcare Provider Details

I. General information

NPI: 1316551237
Provider Name (Legal Business Name): PINNACLE HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 200
ALEXANDRIA VA
22304-1306
US

IV. Provider business mailing address

1390 CHAIN BRIDGE RD # 10033
MC LEAN VA
22101-3904
US

V. Phone/Fax

Practice location:
  • Phone: 703-957-9420
  • Fax: 703-419-3992
Mailing address:
  • Phone: 336-624-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KURWA NEEMAT NYIGU
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 336-624-7164