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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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1457696403
Entity Type Code : Organization
Provider Name (Legal Business Name) : PIONEER HEALTH SERVICES OF CHOCTAW COUNTY, LLC
Provider Business Mailing Address
First Line : 8613 MS HIGHWAY 12
Second Line :
City : ACKERMAN
State : MS
Zip : 39735-8917
Country : US
Telephone Number : 601-849-6440
Fax Number : 601-849-1318
Provider Business Practice Location Address
First Line : 8613 MS HIGHWAY 12
Second Line :
City : ACKERMAN
State : MS
Zip : 39735-8917
Country : US
Telephone Number : 601-849-6440
Fax Number : 601-849-1318
Authorized Official
Title or Position : CEO
Name : JOSEPH S MCNULTY III
Credential :
Telephone Number : 601-849-6440
Provider Enumeration Date : 12/03/2012
Last Update Date : 12/03/2012

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Directions to “PIONEER HEALTH SERVICES OF CHOCTAW COUNTY, LLC ” Practice Location

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