Provider Demographics
NPI:1336153063
Name:PINNACLE HEALTH MEDICAL SERVICES
Entity Type:Organization
Organization Name:PINNACLE HEALTH MEDICAL SERVICES
Other - Org Name:CYSTIC FIBROSIS & PEDIATRIC PULMONARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGENDERFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-231-8200
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-231-8960
Mailing Address - Fax:717-231-8964
Practice Address - Street 1:2501 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1904
Practice Address - Country:US
Practice Address - Phone:717-782-4790
Practice Address - Fax:717-782-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007666760064Medicaid
PA1007666760064Medicaid