Healthcare Provider Details

I. General information

NPI: 1508147216
Provider Name (Legal Business Name): PIONEER HEALTH SERVICES OF CHOCTAW COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W CHERRY ST
ACKERMAN MS
39735-8708
US

IV. Provider business mailing address

311 W CHERRY ST
ACKERMAN MS
39735-8708
US

V. Phone/Fax

Practice location:
  • Phone: 662-285-1928
  • Fax:
Mailing address:
  • Phone: 662-285-1928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateMS

VIII. Authorized Official

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