Provider Demographics
NPI:1700067782
Name:PINNACLE HEALTH MEDICAL SERVICES
Entity Type:Organization
Organization Name:PINNACLE HEALTH MEDICAL SERVICES
Other - Org Name:PINNACLE HEALTH FAMILY CARE OF HALIFAX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESEIDENT & 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:717-231-8964
Practice Address - Street 1:36 S RIVER RD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:PA
Practice Address - Zip Code:17032-8604
Practice Address - Country:US
Practice Address - Phone:717-896-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007666760064Medicaid
PA1007666760064Medicaid