Provider Demographics
NPI:1912294687
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 DANBURY
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 1:1020 HOSPICE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:NC
Mailing Address - Zip Code:27016-0000
Mailing Address - Country:US
Mailing Address - Phone:336-593-8281
Mailing Address - Fax:336-593-5282
Practice Address - Street 1:1020 HOSPICE DRIVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:NC
Practice Address - Zip Code:27016-0000
Practice Address - Country:US
Practice Address - Phone:336-593-8281
Practice Address - Fax:336-593-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918563Medicaid
NC5918563Medicaid