Provider Demographics
NPI:1508204215
Name:PINNACLE HEALTH MEDICAL SERVICES
Entity Type:Organization
Organization Name:PINNACLE HEALTH MEDICAL SERVICES
Other - Org Name:COLONIAL PARK FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-231-8210
Mailing Address - Street 1:118 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1677
Mailing Address - Country:US
Mailing Address - Phone:717-231-8539
Mailing Address - Fax:
Practice Address - Street 1:4807 JONESTOWN RD
Practice Address - Street 2:SUITE 141
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-1739
Practice Address - Country:US
Practice Address - Phone:717-657-3030
Practice Address - Fax:717-671-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007666760 0064Medicaid
PA029490Medicare PIN