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NPI Code Detail

MEDICARE: PIONEER HEALTH SERVICES OF CHOCTAW COUNTY, LLC

MEDICARE: PIONEER HEALTH SERVICES OF CHOCTAW COUNTY, LLC
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
1282NC0060XCritical Access Hospital

General Provider Information

NPI Number : 1366724197
Entity Type Code : Organization
Provider Name (Legal Business Name) : PIONEER HEALTH SERVICES OF CHOCTAW COUNTY, LLC
Provider Business Mailing Address
First Line : 311 WEST CHERRY STREET
Second Line :
City : ACKERMAN
State : MS
Zip : 39735-8708
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 311 WEST CHERRY STREET
Second Line :
City : ACKERMAN
State : MS
Zip : 39735-8708
Country : US
Telephone Number : 662-285-1974
Fax Number :
Authorized Official
Title or Position : CEO
Name : JOSEPH S MCNULTY III
Credential :
Telephone Number : 601-849-6440
Provider Enumeration Date : 09/19/2011
Last Update Date : 09/19/2011

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