Basic Information
| Provider Information | |||||||||
| NPI: | 1720190861 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINNACLE ORTHOPEDIC & SPINE SPECIALISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168545700 | ||||||||
| FaxNumber: | 7168545800 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168545700 | ||||||||
| FaxNumber: | 7168545800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 02/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | HUCKELL | ||||||||
| AuthorizedOfficialFirstName: | CAMERON | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7168545700 | ||||||||
| 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 | 332B00000X | 208367-1 | NY | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.