Basic Information
| Provider Information | |||||||||
| NPI: | 1518272764 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINNACLE HEALTH MEDICAL SERVICES | ||||||||
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| OtherOrganizationName: | PINNACLEHEALTH PEDIATRIC ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 S 2ND ST | ||||||||
| Address2: | SUITE 2F | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041612 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8105 ADAMS DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HUMMELSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170368625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176521211 | ||||||||
| FaxNumber: | 7176524948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2010 | ||||||||
| LastUpdateDate: | 03/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | GUARNESCHELLI | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP-CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7172318200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1007666760064 | 05 | PA | MEDICAID |