Healthcare Provider Details

I. General information

NPI: 1518236397
Provider Name (Legal Business Name): PIONEER HEALTH SERVICES OF STOKES COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 NC 8 AND 89 HWY N
DANBURY NC
27016-7360
US

IV. Provider business mailing address

1570 NC 8 AND 89 HWY N
DANBURY NC
27016-7360
US

V. Phone/Fax

Practice location:
  • Phone: 336-593-5311
  • Fax: 336-593-5311
Mailing address:
  • Phone: 336-593-5311
  • Fax: 336-593-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH0165
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH S MCNULTY III
Title or Position: CEO
Credential:
Phone: 601-849-1682