1386079614 NPI number — PINNACLE HEALTH MEDICAL SERVICES

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 1386079614 NPI number — PINNACLE HEALTH MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HEALTH MEDICAL SERVICES
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:
Provider Other Organization Name Type Code:
6
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:
1386079614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 S 2ND ST
Provider Second Line Business Mailing Address:
SUITE 2F
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17104-1612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 WATERFORD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17050-8268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-591-3630
Provider Business Practice Location Address Fax Number:
717-591-3631
Provider Enumeration Date:
09/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PUGH
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
H
Authorized Official Title or Position:
SENIOR VP
Authorized Official Telephone Number:
717-231-8245

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , 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)

  • Identifier: 100766676 0064 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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