| Pinnacle Allergy Clinic, Pllc | |
|
16101 Cantrell Rd Ste 104 Little Rock AR 72223-4578 | |
| (501) 425-0322 | |
| Not Available |
| Full Name | Pinnacle Allergy Clinic, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 16101 Cantrell Rd Ste 104, Little Rock, Arkansas |
| Authorized Official Name and Position | Deanna Nicholson Ruddell (OWNER) |
| Authorized Official Contact | 5015576445 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pinnacle Allergy Clinic, Pllc 16101 Cantrell Rd Ste 104 Little Rock AR 72223-4578 Ph: (501) 557-6445 | Pinnacle Allergy Clinic, Pllc 16101 Cantrell Rd Ste 104 Little Rock AR 72223-4578 Ph: (501) 425-0322 |
| NPI Number | 1346753332 |
|---|---|
| Provider Enumeration Date | 11/13/2017 |
| Last Update Date | 12/28/2017 |
| Medicare PECOS PAC ID | 7618237363 |
|---|---|
| Medicare Enrollment ID | O20180129001465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346753332 | NPI | - | NPPES |
| 129401001 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | N8430 (Arkansas) | Primary |
| Provider Name | Deanna Ruddell |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1083606156 PECOS PAC ID: 2365454345 Enrollment ID: I20100421000567 |
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