Provider Demographics
NPI:1003104662
Name:PIONEER HEALTH SERVICES OF PATRICK COUNTY, INC.
Entity Type:Organization
Organization Name:PIONEER HEALTH SERVICES OF PATRICK COUNTY, INC.
Other - Org Name:PIONEER FAMILY MEDICAL OF SPENCER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:601-849-6440
Mailing Address - Street 1:19229 A. L. PHILPOTT HWY
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:VA
Mailing Address - Zip Code:24165-0000
Mailing Address - Country:US
Mailing Address - Phone:276-957-7007
Mailing Address - Fax:276-957-7011
Practice Address - Street 1:19229 A. L. PHILPOTT HWY
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:VA
Practice Address - Zip Code:24165-0000
Practice Address - Country:US
Practice Address - Phone:276-957-7007
Practice Address - Fax:276-957-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center