Basic Information
Provider Information | |||||||||
NPI: | 1447490354 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PINNACLE HEALTH MEDICAL SERVICES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ACUPUNCTURIST SERVICES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 409 S 2ND ST | ||||||||
Address2: | PO BOX 1286 | ||||||||
City: | HARRISBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 171041612 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172318960 | ||||||||
FaxNumber: | 7172318964 | ||||||||
Practice Location | |||||||||
Address1: | 2015 TECHNOLOGY PKWY | ||||||||
Address2: | SUITE 211 | ||||||||
City: | MECHANICSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 170509497 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7177912610 | ||||||||
FaxNumber: | 7177312611 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/05/2009 | ||||||||
LastUpdateDate: | 05/23/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MARKLEY | ||||||||
AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
AuthorizedOfficialMiddleName: | P | ||||||||
AuthorizedOfficialTitleorPosition: | SENIOR VP | ||||||||
AuthorizedOfficialTelephone: | 7172318210 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist |   |
ID Information
ID | Type | State | Issuer | Description | 1007666760064 | 05 | PA |   | MEDICAID | 029490 | 01 | PA | MEDICARE GROUP PROVIDER NUMBER | OTHER |