Provider Demographics
NPI:1174391031
Name:PINNACLE MEDICAL GROUP HICKS PC
Entity type:Organization
Organization Name:PINNACLE MEDICAL GROUP HICKS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELVIRA
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-848-5125
Mailing Address - Street 1:699 SIERRA ROSE DR # AB
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2369
Mailing Address - Country:US
Mailing Address - Phone:775-204-4000
Mailing Address - Fax:
Practice Address - Street 1:180 E WINNIE LN
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-2268
Practice Address - Country:US
Practice Address - Phone:775-204-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care