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NPI Code Detail

MEDICARE: PIONEER HEALTH SERVICES OF STOKES COUNTY, INC.

MEDICARE: PIONEER HEALTH SERVICES OF STOKES COUNTY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0002XEmergency Care Clinic/Center
2261QU0200XUrgent Care Clinic/Center

General Provider Information

NPI Number : 1114214871
Entity Type Code : Organization
Provider Name (Legal Business Name) : PIONEER HEALTH SERVICES OF STOKES COUNTY, INC.
Provider Business Mailing Address
First Line : 402 W KING ST
Second Line :
City : KING
State : NC
Zip : 27021-9170
Country : US
Telephone Number : 336-983-9617
Fax Number : 336-983-9791
Provider Business Practice Location Address
First Line : 402 W KING ST
Second Line :
City : KING
State : NC
Zip : 27021-9170
Country : US
Telephone Number : 336-983-9617
Fax Number : 336-983-9791
Authorized Official
Title or Position : CEO
Name : JOSEPH S MCNULTY III
Credential :
Telephone Number : 601-849-6440
Provider Enumeration Date : 07/01/2011
Last Update Date : 11/20/2015

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