Provider Demographics
NPI:1851354633
Name:PIONEER PHYSICIANS NETWORK, INC.
Entity Type:Organization
Organization Name:PIONEER PHYSICIANS NETWORK, INC.
Other - Org Name:
Other - Org Type:
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 1:3515 MASSILLON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7854
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-899-9363
Practice Address - Street 1:3515 MASSILLON RD STE 300
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7854
Practice Address - Country:US
Practice Address - Phone:330-899-9350
Practice Address - Fax:330-899-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PI9285671Medicare PIN