Provider Demographics
NPI:1245419639
Name:PINNACLE HEALTH PARTNERS INC.
Entity type:Organization
Organization Name:PINNACLE HEALTH PARTNERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-226-2151
Mailing Address - Street 1:415 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-4411
Mailing Address - Country:US
Mailing Address - Phone:570-208-5571
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 2170
Practice Address - Street 2:
Practice Address - City:TAFTON
Practice Address - State:PA
Practice Address - Zip Code:18464-9714
Practice Address - Country:US
Practice Address - Phone:570-226-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013208020002Medicaid
PA393895Medicare Oscar/Certification