Healthcare Provider Details

I. General information

NPI: 1528344850
Provider Name (Legal Business Name): PIONEER PHYSICIANS NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GREENWICH RD STE 8
NORTON OH
44203-5780
US

IV. Provider business mailing address

3300 GREENWICH RD STE 8
NORTON OH
44203-5780
US

V. Phone/Fax

Practice location:
  • Phone: 330-825-7371
  • Fax: 330-634-1329
Mailing address:
  • Phone: 330-825-7371
  • Fax: 330-634-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN M KOSTELNICK
Title or Position: PRACTICE ADMINISTRATOR
Credential: CMM
Phone: 330-899-9350