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General NPI Number Information
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NPI Number | 1831347095
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Entity Type | Organization
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Legal Business Name | PINNACLE SURGICAL GROUP, PC
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 2710 HARNEY ST SUITE 204
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City | LARAMIE
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State | WY
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Zip | 82072-2884
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Country | US
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Telephone | 307-460-2055
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Fax | 307-460-2058
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Provider Business Mailing Address
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Address Line | 2710 HARNEY ST SUITE 204
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City | LARAMIE
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State | WY
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Zip | 82072-2884
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Country | US
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Telephone | 307-460-2055
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Fax | 307-460-2058
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Authorized Official
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Title or Position | M.D. / OWNER
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Name | ROCHELLE DAWN STARK
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Credential | M.D.
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Telephone | 307-460-2055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 1040 (TEMPORARY)
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License Number State | WY
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