MEDICARE: PINNACLE MEDICAL GROUP, HICKS PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1619656139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE MEDICAL GROUP, HICKS PC

Provider Business Mailing Address
First Line	:	5975 S LOS ALTOS PKWY STE 9
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89436-7699
Country	:	US
Telephone Number	:	775-204-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5990 SILVER LAKE RD STE C
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89506-2300
Country	:	US
Telephone Number	:	775-972-9100
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MARIA ELVIRA ROGERS
Credential	:
Telephone Number	:	775-848-5125

Provider Enumeration Date	:	07/12/2023
Last Update Date	:	07/12/2023

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