Healthcare Provider Details

I. General information

NPI: 1083983589
Provider Name (Legal Business Name): PIONEER HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N CLIFTON ST
FORDYCE AR
71742-3026
US

IV. Provider business mailing address

110 PIONEER WAY
MAGEE MS
39111-5501
US

V. Phone/Fax

Practice location:
  • Phone: 870-352-6300
  • Fax:
Mailing address:
  • Phone: 601-849-6440
  • Fax: 601-849-1309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH S. MCNULTY
Title or Position: CEO
Credential:
Phone: 601-849-6440