Healthcare Provider Details

I. General information

NPI: 1306133079
Provider Name (Legal Business Name): PIONEER HEALTH SERVICES OF STOKES COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 HOSPICE DRIVE
DANBURY NC
27016-1030
US

IV. Provider business mailing address

1030 HOSPICE DRIVE
DANBURY NC
27016-1030
US

V. Phone/Fax

Practice location:
  • Phone: 336-593-5354
  • Fax: 336-593-5331
Mailing address:
  • Phone: 336-593-5354
  • Fax: 336-593-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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