Provider Demographics
NPI:1386723369
Name:PINNACLE HEALTHCARE OF OKLAHOMA, LLP
Entity type:Organization
Organization Name:PINNACLE HEALTHCARE OF OKLAHOMA, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-609-7900
Mailing Address - Street 1:10512 N 110 EAST AVENUE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055
Mailing Address - Country:US
Mailing Address - Phone:918-609-7900
Mailing Address - Fax:918-609-1320
Practice Address - Street 1:10512 N 110 EAST AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055
Practice Address - Country:US
Practice Address - Phone:918-609-7900
Practice Address - Fax:918-609-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty