Provider Demographics
NPI:1619119575
Name:PIONEER PHYSICIANS NETWORK, INC.
Entity Type:Organization
Organization Name:PIONEER PHYSICIANS NETWORK, INC.
Other - Org Name:INTERNAL MEDICINE OF GREENE
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 1:1640 CORPORATE WOODS CIR
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:330-899-9395
Practice Address - Street 1:3593 S ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5271
Practice Address - Country:US
Practice Address - Phone:330-899-9070
Practice Address - Fax:330-899-0651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIONEER PHYSICIANS NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-24
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003114207R00000X
OH35073082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty