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General NPI Number Information
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NPI Number | 1730461211
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Entity Type | Organization
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Legal Business Name | PIONEER HEALTH SERVICES OF CHOCTAW COUNTY, LLC
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 780 MAIN STREET
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City | WEIR
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State | MS
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Zip | 39772-0000
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Country | US
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Telephone | 662-547-9407
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Fax | 662-547-9408
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Provider Business Mailing Address
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Address Line | 780 MAIN STREET
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City | WEIR
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State | MS
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Zip | 39772-0000
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Country | US
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Telephone | 662-547-9407
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Fax | 662-547-9408
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH S MCNULTY III
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Credential |
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Telephone | 662-547-9407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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