Provider Demographics
NPI:1538197322
Name:PINNACLE HEALTH PARTNERS INC
Entity type:Organization
Organization Name:PINNACLE HEALTH PARTNERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-226-2151
Mailing Address - Street 1:132 MANLY RD
Mailing Address - Street 2:
Mailing Address - City:TAFTON
Mailing Address - State:PA
Mailing Address - Zip Code:18464-7829
Mailing Address - Country:US
Mailing Address - Phone:570-226-2151
Mailing Address - Fax:570-226-1861
Practice Address - Street 1:132 MANLY RD
Practice Address - Street 2:
Practice Address - City:TAFTON
Practice Address - State:PA
Practice Address - Zip Code:18464-7829
Practice Address - Country:US
Practice Address - Phone:570-226-2151
Practice Address - Fax:570-226-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013208020001Medicaid
PA1013208020001Medicaid
PA092242Medicare PIN