MEDICARE: PIONEER PHYSICIANS NETWORK, 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
1	208000000X	Pediatrics Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1528344850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIONEER PHYSICIANS NETWORK, INC.

Provider Business Mailing Address
First Line	:	3300 GREENWICH RD
Second Line	:	STE 8
City	:	NORTON
State	:	OH
Zip	:	44203-5780
Country	:	US
Telephone Number	:	330-825-7371
Fax Number	:	330-634-1329

Provider Business Practice Location Address
First Line	:	3300 GREENWICH RD
Second Line	:	STE 8
City	:	NORTON
State	:	OH
Zip	:	44203-5780
Country	:	US
Telephone Number	:	330-825-7371
Fax Number	:	330-634-1329

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	KATHLEEN M KOSTELNICK
Credential	:	CMM
Telephone Number	:	330-899-9350

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	08/14/2020

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