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General NPI Number Information
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NPI Number | 1457013930
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Entity Type | Organization
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Legal Business Name | PIONEER MEDICAL CLINICS PLLC
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 1311 E MAIN ST
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City | PIGGOTT
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State | AR
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Zip | 72454-9400
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Country | US
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Telephone | 901-603-6113
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 E MAIN ST
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City | PIGGOTT
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State | AR
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Zip | 72454-9400
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Country | US
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Telephone | 901-603-6113
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFERY B COPELAND
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Credential | MD
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Telephone | 901-603-6113
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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 |
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License Number State |
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