Provider Demographics
NPI:1558651026
Name:PIONEER PHYSICIANS NETWORK, INC.
Entity Type:Organization
Organization Name:PIONEER PHYSICIANS NETWORK, INC.
Other - Org Name:
Other - Org Type:
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:44685-7819
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-899-9267
Practice Address - Street 1:133 WILBUR DR NE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1641
Practice Address - Country:US
Practice Address - Phone:330-494-6012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies