MEDICARE: PINNACLE MEDICAL CLINIC, P.A.

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	207R00000X	Internal Medicine Physician	9800405	NC

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	:	1891843967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE MEDICAL CLINIC, P.A.

Provider Business Mailing Address
First Line	:	2401 TUCKASEEGEE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208
Country	:	US
Telephone Number	:	704-409-3000
Fax Number	:	704-409-2382

Provider Business Practice Location Address
First Line	:	2401 TUCKASEEGEE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-4058
Country	:	US
Telephone Number	:	704-409-3000
Fax Number	:	704-409-2382

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JENNYFFER BARCELO
Credential	:
Telephone Number	:	704-409-3000

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	03/26/2024

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