MEDICARE: PINNACLE HEALTH INTEGRATIVE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1245797687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE HEALTH INTEGRATIVE SERVICES LLC

Provider Business Mailing Address
First Line	:	409 S 2ND ST STE 2F
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17104-1612
Country	:	US
Telephone Number	:	717-231-8929
Fax Number	:	717-221-5673

Provider Business Practice Location Address
First Line	:	8012 BRETZ DR
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-9748
Country	:	US
Telephone Number	:	717-988-9340
Fax Number	:	717-231-8656

Authorized Official
Title or Position	:	SENIOR VP
Name	:	CHRISTOPHER P MARKLEY
Credential	:
Telephone Number	:	717-231-8210

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	02/21/2019

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