Provider Demographics
NPI:1043493851
Name:PINNACLE MEDICAL CLINIC INC
Entity type:Organization
Organization Name:PINNACLE MEDICAL CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAFP
Authorized Official - Phone:601-684-7771
Mailing Address - Street 1:7900 HIGHWAY 570
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-7563
Mailing Address - Country:US
Mailing Address - Phone:601-684-7771
Mailing Address - Fax:601-684-1616
Practice Address - Street 1:7900 HIGHWAY 570
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666-7563
Practice Address - Country:US
Practice Address - Phone:601-684-7771
Practice Address - Fax:601-684-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14467261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03522321Medicaid
MS258968Medicare Oscar/Certification
MS258968Medicare PIN