Healthcare Provider Details

I. General information

NPI: 1396129714
Provider Name (Legal Business Name): PIONEER HEALTH SERVICES OF ONEIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20445 ALBERTA ST
ONEIDA TN
37841-3509
US

IV. Provider business mailing address

20445 ALBERTA ST
ONEIDA TN
37841-3509
US

V. Phone/Fax

Practice location:
  • Phone: 423-569-2754
  • Fax: 423-569-2756
Mailing address:
  • Phone: 423-569-2754
  • Fax: 423-569-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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