Provider Demographics
NPI:1508147216
Name:PIONEER HEALTH SERVICES OF CHOCTAW COUNTY, LLC
Entity Type:Organization
Organization Name:PIONEER HEALTH SERVICES OF CHOCTAW COUNTY, LLC
Other - Org Name:PIONEER COMMUNITY HOSPITAL OF CHOCTAW
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 1:311 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:ACKERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39735-8708
Mailing Address - Country:US
Mailing Address - Phone:662-285-1928
Mailing Address - Fax:
Practice Address - Street 1:311 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735-8708
Practice Address - Country:US
Practice Address - Phone:662-285-1928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QE0002X
MS282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS251334OtherCCN