Provider Demographics
NPI:1760807648
Name:PIONEER HEALTH SERVICES OF STOKES COUNTY, INC.
Entity Type:Organization
Organization Name:PIONEER HEALTH SERVICES OF STOKES COUNTY, INC.
Other - Org Name:PIONEER FAMILY MEDICAL OF RURAL HALL
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 1:100 E WALL ST
Mailing Address - Street 2:
Mailing Address - City:RURAL HALL
Mailing Address - State:NC
Mailing Address - Zip Code:27045-9312
Mailing Address - Country:US
Mailing Address - Phone:336-969-9158
Mailing Address - Fax:
Practice Address - Street 1:100 E WALL ST
Practice Address - Street 2:
Practice Address - City:RURAL HALL
Practice Address - State:NC
Practice Address - Zip Code:27045-9312
Practice Address - Country:US
Practice Address - Phone:336-969-9158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center