Healthcare Provider Details

I. General information

NPI: 1174296172
Provider Name (Legal Business Name): PIONEER PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 FULTON DR NW
CANTON OH
44718-1727
US

IV. Provider business mailing address

3515 MASSILLON RD STE 300
UNIONTOWN OH
44685-7854
US

V. Phone/Fax

Practice location:
  • Phone: 330-899-1051
  • Fax: 330-634-1329
Mailing address:
  • Phone: 234-271-3353
  • Fax: 330-899-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAULA MOORE
Title or Position: CREDENTIALING LIAISION
Credential:
Phone: 234-271-3353