Basic Information
| Provider Information | |||||||||
| NPI: | 1790029205 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINNACLE MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 12209 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924232209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093354118 | ||||||||
| FaxNumber: | 9097932916 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 S HIGHLAND SPRINGS AVE | ||||||||
| Address2: | SUITE 2D | ||||||||
| City: | BANNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922206504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517695378 | ||||||||
| FaxNumber: | 9517695645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2012 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | SABBAH | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9098814115 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PINNACLE MEDICAL GROUP, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 332B00000X | CA | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.