Provider Demographics
NPI:1184816720
Name:PIONEER PEDIATRICS, PLLC
Entity type:Organization
Organization Name:PIONEER PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:PNP
Authorized Official - Phone:931-815-5437
Mailing Address - Street 1:236 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2508
Mailing Address - Country:US
Mailing Address - Phone:931-815-5437
Mailing Address - Fax:931-507-5440
Practice Address - Street 1:236 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2508
Practice Address - Country:US
Practice Address - Phone:931-815-5437
Practice Address - Fax:931-507-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1618208000000X
TN1768208000000X
TNAPN0000012370363LP0200X
TN36250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134121783OtherNPI
1316949969OtherNPI
TN5440223Medicaid
TN5440799Medicaid
TN5441183Medicaid
1225166564OtherNPI
1336183227OtherNPI
TN3878545Medicaid