MEDICARE: PINNACLE HEALTH MEDICAL SERVICES

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104860444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE HEALTH MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	409 S 2ND ST
Second Line	:	PO BOX 1286
City	:	HARRISBURG
State	:	PA
Zip	:	17104-1612
Country	:	US
Telephone Number	:	717-231-8960
Fax Number	:	717-231-8964

Provider Business Practice Location Address
First Line	:	1001 E WICONISCO AVE
Second Line	:
City	:	TOWER CITY
State	:	PA
Zip	:	17980-1612
Country	:	US
Telephone Number	:	717-647-2297
Fax Number	:	717-647-2672

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	05/20/2011

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