1225238298 NPI number — PINNACLE HEALTH COMMUNITY CAMPUS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225238298 NPI number — PINNACLE HEALTH COMMUNITY CAMPUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HEALTH COMMUNITY CAMPUS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY GENERAL OSTEOPATHIC HOSPITAL
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225238298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 LONDONDERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17109-5317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-657-7458
Provider Business Mailing Address Fax Number:
717-657-7555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 LONDONDERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17109-5317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-657-7458
Provider Business Practice Location Address Fax Number:
717-657-7555
Provider Enumeration Date:
07/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KREISER
Authorized Official First Name:
JUANITA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
INTERN TACKING INTERNAL MEDICINE
Authorized Official Telephone Number:
717-507-9450

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  OT012032 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: OT012032 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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