Provider Demographics
NPI:1043323561
Name:PINNACLE PROSTHETICS, INC.
Entity type:Organization
Organization Name:PINNACLE PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:662-983-2500
Mailing Address - Street 1:225 E CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:BRUCE
Mailing Address - State:MS
Mailing Address - Zip Code:38915-9341
Mailing Address - Country:US
Mailing Address - Phone:662-983-2500
Mailing Address - Fax:662-983-2500
Practice Address - Street 1:225 E CALHOUN ST
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MS
Practice Address - Zip Code:38915-9341
Practice Address - Country:US
Practice Address - Phone:662-983-2500
Practice Address - Fax:662-983-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03777044Medicaid
MS03777044Medicaid
MS5169980001Medicare ID - Type Unspecified