Provider Demographics
NPI:1225238298
Name:PINNACLE HEALTH COMMUNITY CAMPUS
Entity Type:Organization
Organization Name:PINNACLE HEALTH COMMUNITY CAMPUS
Other - Org Name:COMMUNITY GENERAL OSTEOPATHIC HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INTERN TACKING INTERNAL MEDICINE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KREISER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-507-9450
Mailing Address - Street 1:4300 LONDONDERRY RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5317
Mailing Address - Country:US
Mailing Address - Phone:717-657-7458
Mailing Address - Fax:717-657-7555
Practice Address - Street 1:4300 LONDONDERRY RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5317
Practice Address - Country:US
Practice Address - Phone:717-657-7458
Practice Address - Fax:717-657-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012032261QP2300X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care