Provider Demographics
NPI:1457013930
Name:PIONEER MEDICAL CLINICS PLLC
Entity Type:Organization
Organization Name:PIONEER MEDICAL CLINICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:B
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-603-6113
Mailing Address - Street 1:1311 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-9400
Mailing Address - Country:US
Mailing Address - Phone:901-603-6113
Mailing Address - Fax:
Practice Address - Street 1:1311 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-9400
Practice Address - Country:US
Practice Address - Phone:901-603-6113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty