Provider Demographics
NPI:1295978302
Name:SUMMIT PULMONARY, PC
Entity type:Organization
Organization Name:SUMMIT PULMONARY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:PENDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FCCP
Authorized Official - Phone:814-849-8329
Mailing Address - Street 1:111 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1422
Mailing Address - Country:US
Mailing Address - Phone:814-849-8329
Mailing Address - Fax:814-849-5441
Practice Address - Street 1:111 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1422
Practice Address - Country:US
Practice Address - Phone:814-849-8329
Practice Address - Fax:814-849-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428157174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017702250001Medicaid
PA1017702250001Medicaid