MEDICARE: PINNACLE RADIOLOGY SERVICES

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1710486816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE RADIOLOGY SERVICES

Provider Business Mailing Address
First Line	:	10567 SAWMILL PKWY STE 100
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-6671
Country	:	US
Telephone Number	:	614-210-1885
Fax Number	:

Provider Business Practice Location Address
First Line	:	5263 S HIGHWAY 95
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9223
Country	:	US
Telephone Number	:	928-855-8185
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BOBBY AJAY SHAH
Credential	:
Telephone Number	:	928-855-8185

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	02/05/2018

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