Healthcare Provider Details

I. General information

NPI: 1689893620
Provider Name (Legal Business Name): PIONEER MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GREENWAY CIR
ERWIN TN
37650-2177
US

IV. Provider business mailing address

PO BOX 1433
ERWIN TN
37650-2223
US

V. Phone/Fax

Practice location:
  • Phone: 423-743-1271
  • Fax:
Mailing address:
  • Phone: 423-743-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK T WEGMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 423-743-2240