Provider Demographics
NPI:1144668195
Name:PIONEER HEALTH SERVICES OF STOKES COUNTY, INC
Entity type:Organization
Organization Name:PIONEER HEALTH SERVICES OF STOKES COUNTY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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 1:167 MOORE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-8770
Mailing Address - Country:US
Mailing Address - Phone:336-983-6898
Mailing Address - Fax:336-983-6921
Practice Address - Street 1:167 MOORE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8770
Practice Address - Country:US
Practice Address - Phone:336-983-6898
Practice Address - Fax:336-983-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center