PINNACLE MEDICAL GROUP PA
Clinical Neuropsychologist
Bradenton, Florida
Provider NPI: 1316963077
Organization Information:Organization Name: PINNACLE MEDICAL GROUP PA
Organization is not Subpart
Authorized Official: MARC STEPHEN KALLINS PRESIDENT 941-7500602
Practice Location:
315 75TH ST W BRADENTON, FL 34209 US
Tel: 941-761-1998 Fax: 941-761-0395
Business Mailing Address:
315 75TH ST W BRADENTON, FL 34209 US
Tel: 941-761-1998 Fax: 941-761-0395
Entity Type: Organization
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Organization is not Subpart
Authorized Official: MARC STEPHEN KALLINS PRESIDENT 941-7500602
Practice Location:
315 75TH ST W BRADENTON, FL 34209 US
Tel: 941-761-1998 Fax: 941-761-0395
Business Mailing Address:
315 75TH ST W BRADENTON, FL 34209 US
Tel: 941-761-1998 Fax: 941-761-0395
Entity Type: Organization
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 103G00000X | Behavioral Health & Social Service Providers Clinical Neuropsychologist | FL | PY6258 |
N | 207P00000X | Physicians Emergency Medicine | FL | ME34789 |
Y | 207Q00000X | Physicians Family Medicine | FL | ME13523 |
N | 207R00000X | Physicians Internal Medicine | FL | ME44610 |
N | 207RC0000X | Physicians Internal Medicine | FL | ME11749 |
N | 207RR0500X | Physicians Internal Medicine | FL | ME64188 |
N | 207T00000X | Physicians Neurological Surgery | FL | ME68033 |
N | 207X00000X | Physicians Orthopaedic Surgery | FL | ME74784 |
N | 208100000X | Physicians Physical Medicine & Rehabilitation | FL | ME40567 |
N | 2084N0400X | Physicians Psychiatry & Neurology | FL | ME72170 |
N | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist | FL | PT18064 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
254897604 | FL | 05 | |
254897605 | FL | 05 | |
254897601 | FL | 05 | |
254897602 | FL | 05 | |
254897603 | FL | 05 | |
BCBS | 21818 | FL | 01 |
254897600 | FL | 05 | |
MEDICARE RAILROAD | CN7277 | FL | 01 |
MEDICARE RAILROAD | CH1832 | FL | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
CLINICAL NEUROPSYCHOLOGIST JOBS FL - Page 1
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