Healthcare Provider Details

I. General information

NPI: 1285897629
Provider Name (Legal Business Name): PIONEER HEALTH SERVCES OF PATRICK COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 WOODLAND DR
STUART VA
24171-1586
US

IV. Provider business mailing address

PO BOX 1100
MAGEE MS
39111-1100
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-6677
  • Fax: 276-694-6827
Mailing address:
  • Phone: 601-849-1682
  • Fax: 601-849-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101049407
License Number StateVA

VIII. Authorized Official

Name: JOSEPH S MCNULTY III
Title or Position: CEO/PRESIDENT
Credential:
Phone: 601-849-4112