Provider Demographics
NPI:1649433467
Name:PINNACLE HEALTH MEDICAL SERVICES
Entity type:Organization
Organization Name:PINNACLE HEALTH MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:PO BOX 1286
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17108-1286
Mailing Address - Country:US
Mailing Address - Phone:717-231-8960
Mailing Address - Fax:
Practice Address - Street 1:111 SOUTH FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17105
Practice Address - Country:US
Practice Address - Phone:717-231-8960
Practice Address - Fax:717-231-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA029490OtherMEDICARE GROUP
PA1007666760064Medicaid