Provider Demographics
NPI:1689893620
Name:PIONEER MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:PIONEER MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-743-2240
Mailing Address - Street 1:PO BOX 1433
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-2223
Mailing Address - Country:US
Mailing Address - Phone:423-743-2240
Mailing Address - Fax:
Practice Address - Street 1:100 GREENWAY CIR
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-2177
Practice Address - Country:US
Practice Address - Phone:423-743-1271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725195Medicaid
TN3725195Medicare ID - Type Unspecified