MEDICARE: PIONEER HEALTH SERVICES OF NEWTON 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
1	275N00000X	Medicare Defined Swing Bed Hospital Unit
2	282NC0060X	Critical Access Hospital

General Provider Information

NPI Number	:	1447253521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIONEER HEALTH SERVICES OF NEWTON COUNTY, LLC

Provider Business Mailing Address
First Line	:	9421 EASTSIDE DRIVE EXTENTION
Second Line	:
City	:	NEWTON
State	:	MS
Zip	:	39345-2613
Country	:	US
Telephone Number	:	601-683-0279
Fax Number	:	601-683-0366

Provider Business Practice Location Address
First Line	:	9421 EASTSIDE DRIVE EXTENTION
Second Line	:
City	:	NEWTON
State	:	MS
Zip	:	39345-2613
Country	:	US
Telephone Number	:	601-683-2031
Fax Number	:	601-683-0264

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPH S MCNULTY III
Credential	:
Telephone Number	:	601-849-6440

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/28/2010

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