Provider Demographics
NPI:1629143136
Name:PIONEER HEALTH SERVICES OF NEWTON COUNTY, LLC
Entity Type:Organization
Organization Name:PIONEER HEALTH SERVICES OF NEWTON COUNTY, LLC
Other - Org Name:PIONEER COMMUNITY HOSPITAL OF NEWTON
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 1:9421 EASTSIDE DRIVE EXTENSION
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345
Mailing Address - Country:US
Mailing Address - Phone:601-683-0279
Mailing Address - Fax:601-683-0264
Practice Address - Street 1:9421 EASTSIDE DRIVE EXTENTION
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345
Practice Address - Country:US
Practice Address - Phone:601-683-0279
Practice Address - Fax:601-683-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16-321273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25M332Medicare PIN