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General NPI Number Information
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NPI Number | 1336384742
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Entity Type | Organization
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Legal Business Name | PIONEER HEALTH CARE , LLC
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Dates
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Enumeration Date | 12/14/2008
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Last Update Date | 09/29/2024
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Provider Practice Location Address
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Address Line | 4297 HWY 42
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City | BASSFIELD
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State | MS
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Zip | 39421
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Country | US
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Telephone | 601-550-3153
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Fax | 601-901-6061
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Provider Business Mailing Address
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Address Line | 15 KEYSTONE DR STE E
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City | HATTIESBURG
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State | MS
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Zip | 39402-6124
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Country | US
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Telephone | 601-550-3153
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Fax | 601-901-6061
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Authorized Official
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Title or Position | OWNER
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Name | BRAD H MASSEY
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Credential | NP
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Telephone | 601-550-3153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | R814032
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License Number State | MS
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