Provider Demographics
NPI:1477929495
Name:PIONEER HEALTH SERVICES OF MONROE COUNTY, INC.
Entity Type:Organization
Organization Name:PIONEER HEALTH SERVICES OF MONROE COUNTY, INC.
Other - Org Name:PIONEER WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:601-849-6440
Mailing Address - Street 1:502 JACKSON ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ABERDEEN
Mailing Address - State:MS
Mailing Address - Zip Code:39730-3300
Mailing Address - Country:US
Mailing Address - Phone:662-369-9500
Mailing Address - Fax:
Practice Address - Street 1:502 JACKSON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-3300
Practice Address - Country:US
Practice Address - Phone:662-369-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center