Basic Information
| Provider Information | |||||||||
| NPI: | 1306104047 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINNACLE HEALTH MANAGEMENT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 600 | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417020600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064357642 | ||||||||
| FaxNumber: | 6064365282 | ||||||||
| Practice Location | |||||||||
| Address1: | 21992 MAIN ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | HYDEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417498567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066724800 | ||||||||
| FaxNumber: | 6064365282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2012 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | TONYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6064391300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 620662500 | 01 | KY | US DEPARTMENT OF LABOR | OTHER | 7100239760 | 05 | KY | MEDICAID |