Provider Demographics
NPI:1487358941
Name:PINNACLE ANESTHESIA GROUP, PLLC
Entity type:Organization
Organization Name:PINNACLE ANESTHESIA GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:SLADE
Authorized Official - Last Name:BRIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:479-426-6744
Mailing Address - Street 1:4452 W HIDDEN ACRES CT
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-6010
Mailing Address - Country:US
Mailing Address - Phone:479-426-6744
Mailing Address - Fax:
Practice Address - Street 1:3721 S CHAMPIONS DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8713
Practice Address - Country:US
Practice Address - Phone:936-870-6125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty