Healthcare Provider Details

I. General information

NPI: 1275566515
Provider Name (Legal Business Name): PIONEER HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 8TH AVE SW
MAGEE MS
39111-3967
US

IV. Provider business mailing address

PO BOX 1100
MAGEE MS
39111-1100
US

V. Phone/Fax

Practice location:
  • Phone: 601-849-6440
  • Fax: 601-849-7557
Mailing address:
  • Phone: 601-849-6440
  • Fax: 601-849-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH S MCNULTY II
Title or Position: PRESIDENT
Credential: CRT
Phone: 601-849-4112