1477827046 NPI number — PINNACLE HEALTH MEDICAL SERVICES

Table of content: (NPI 1477827046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477827046 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:
CREARY SURGERY
Provider Other Organization Name Type Code:
3
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:
1477827046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1286
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:
17108-1286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-231-8960
Provider Business Mailing Address Fax Number:
717-231-8964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2626 N 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-2044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-231-8960
Provider Business Practice Location Address Fax Number:
717-231-8964
Provider Enumeration Date:
02/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MARKLEY
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
717-231-8200

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007666760064 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 029490 . This is a "MEDICARE GROUP ID NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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