Provider Demographics
NPI:1467400929
Name:PIONEER PHYSICIANS NETWORK INC.
Entity Type:Organization
Organization Name:PIONEER PHYSICIANS NETWORK INC.
Other - Org Name:PIONEER PHYSICIANS NETWORK LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOSTELNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-899-9350
Mailing Address - Street 1:3515 MASSILLON RD SUITE 300
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-899-9267
Practice Address - Street 1:65 COMMUNITY RD
Practice Address - Street 2:SUITE A
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2357
Practice Address - Country:US
Practice Address - Phone:330-633-7484
Practice Address - Fax:330-633-7583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
D368761Medicare PIN