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General NPI Number Information
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NPI Number | 1285897629
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Entity Type | Organization
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Legal Business Name | PIONEER HEALTH SERVCES OF PATRICK COUNTY, INC.
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 835 WOODLAND DR
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City | STUART
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State | VA
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Zip | 24171-1586
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Country | US
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Telephone | 276-694-6677
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Fax | 276-694-6827
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Provider Business Mailing Address
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Address Line | PO BOX 1100
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City | MAGEE
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State | MS
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Zip | 39111-1100
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Country | US
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Telephone | 601-849-1682
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Fax | 601-849-1969
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | JOSEPH S MCNULTY III
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Credential |
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Telephone | 601-849-4112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101049407
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License Number State | VA
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