Basic Information
| Provider Information | |||||||||
| NPI: | 1548739964 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINNACLE PAIN MEDICINE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3201 COLORADO BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762106863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404839898 | ||||||||
| FaxNumber: | 9403830643 | ||||||||
| Practice Location | |||||||||
| Address1: | 3201 COLORADO BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762106863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404839898 | ||||||||
| FaxNumber: | 9403830643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2018 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUSSAIN | ||||||||
| AuthorizedOfficialFirstName: | ASADULLAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9404531491 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0014X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1285055483 | 01 | TX | DEEPTI KHULLAR | OTHER | 1982976346 | 01 | TX | MEGAN BRIDGES | OTHER | 1174500540 | 01 | TX | ASAD HUSSAIN | OTHER | 1093792467 | 01 | TX | MARK LOWE | OTHER | 401540601 | 05 | TX | MEDICAID |