Basic Information
| Provider Information | |||||||||
| NPI: | 1336289610 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PINNACLE FAMILY CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5495 S 500 E | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844056923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014757100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5495 S 500 E | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844056923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014757100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | QADER | ||||||||
| AuthorizedOfficialFirstName: | NAMEER | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | FAMILY PRACTICE | ||||||||
| AuthorizedOfficialTelephone: | 8014757100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5300789-1205 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 381173214001 | 05 | UT | MEDICAID |