Healthcare Provider Details

I. General information

NPI: 1669724183
Provider Name (Legal Business Name): PIONEER HEALTH SERVICES OF MONROE COUNTY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 S CHESTNUT ST
ABERDEEN MS
39730-3337
US

IV. Provider business mailing address

502 S CHESTNUT ST
ABERDEEN MS
39730-3337
US

V. Phone/Fax

Practice location:
  • Phone: 601-849-6440
  • Fax: 601-849-1318
Mailing address:
  • Phone: 601-849-6440
  • Fax: 601-849-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number13-033
License Number StateMS

VIII. Authorized Official

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