Provider Demographics
NPI:1982124129
Name:PINNACLE HEALTH REGIONAL PHYSICIANS
Entity Type:Organization
Organization Name:PINNACLE HEALTH REGIONAL PHYSICIANS
Other - Org Name:COLLEGE AVENUE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP, STRAT SVCS/GEN COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-231-8210
Mailing Address - Street 1:409 S 2ND ST STE 2F
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:
Mailing Address - Fax:
Practice Address - Street 1:233 COLLEGE AVE STE 302
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3384
Practice Address - Country:US
Practice Address - Phone:717-291-8512
Practice Address - Fax:717-291-8547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty