Healthcare Provider Details

I. General information

NPI: 1699110254
Provider Name (Legal Business Name): PIONEER HEALTH SERVICES OF ONEIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18797 ALBERTA ST
ONEIDA TN
37841-2127
US

IV. Provider business mailing address

18797 ALBERTA ST
ONEIDA TN
37841-2127
US

V. Phone/Fax

Practice location:
  • Phone: 423-286-5300
  • Fax:
Mailing address:
  • Phone: 423-286-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

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