MEDICARE: PINNACLE PAIN MANAGEMENT AND REHABILITATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	35071099B	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073636312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE PAIN MANAGEMENT AND REHABILITATION LLC

Provider Business Mailing Address
First Line	:	422 N COLUMBUS ST
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-3033
Country	:	US
Telephone Number	:	740-687-2700
Fax Number	:	740-687-2701

Provider Business Practice Location Address
First Line	:	422 N COLUMBUS ST
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-3033
Country	:	US
Telephone Number	:	740-687-2700
Fax Number	:	740-687-2701

Authorized Official
Title or Position	:	OWNER
Name	:	MARK BANKS
Credential	:	M.D.
Telephone Number	:	740-687-2700

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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