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General NPI Number Information
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NPI Number | 1396067310
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Entity Type | Organization
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Legal Business Name | PINNACLE FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 1040 S 8TH STREET SUITE 102
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City | COLORADO SPRINGS
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State | CO
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Zip | 80905
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Country | US
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Telephone | 719-687-8752
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Fax | 719-687-8753
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Provider Business Mailing Address
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Address Line | PO BOX 7275
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City | WOODLAND PARK
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State | CO
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Zip | 80863
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Country | US
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Telephone | 719-687-8752
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Fax | 719-687-8753
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MICHELLE ANN EADS
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Credential | MD
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Telephone | 719-687-8752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36828
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License Number State | CO
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