Basic Information
| Provider Information | |||||||||
| NPI: | 1265632491 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINNACLE RADIOLOGY, PROF. LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3841 GRAND MESA DR | ||||||||
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| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814017115 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 S 3RD ST | ||||||||
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| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814014212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702407314 | ||||||||
| FaxNumber: | 9704978410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2007 | ||||||||
| LastUpdateDate: | 04/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | REMARK | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9702406792 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 38228742 | 05 | CO | MEDICAID |