=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922429745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINNACLE HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2013
-----------------------------------------------------
Last Update Date | 12/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 LINCOLN WAY LYONS PROFESSIONAL BUILDING
-----------------------------------------------------
City | WHITE OAK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15131-1724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-872-5443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1610 N MAIN STREET EXT
-----------------------------------------------------
City | BUTLER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16001-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-282-0755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | ZACHARY RABOLD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-282-0755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------