Provider Demographics
NPI:1760880785
Name:PIONEER HEALTH SERVICES OF MONROE COUNTY, INC.
Entity Type:Organization
Organization Name:PIONEER HEALTH SERVICES OF MONROE COUNTY, INC.
Other - Org Name:PIONEER SURGICAL CLINIC OF ABERDEEN
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 1:502 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MS
Mailing Address - Zip Code:39730-3337
Mailing Address - Country:US
Mailing Address - Phone:662-369-9501
Mailing Address - Fax:
Practice Address - Street 1:502 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-3337
Practice Address - Country:US
Practice Address - Phone:662-369-9501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIONEER HEALTH SERVICES OF MONROE COUNTY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-08
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16230261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center