Provider Demographics
NPI:1528344850
Name:PIONEER PHYSICIANS NETWORK, INC.
Entity type:Organization
Organization Name:PIONEER PHYSICIANS NETWORK, INC.
Other - Org Name:<UNAVAIL>
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:CMM
Authorized Official - Phone:330-899-9350
Mailing Address - Street 1:3300 GREENWICH RD
Mailing Address - Street 2:STE 8
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-5780
Mailing Address - Country:US
Mailing Address - Phone:330-825-7371
Mailing Address - Fax:330-634-1329
Practice Address - Street 1:3300 GREENWICH RD
Practice Address - Street 2:STE 8
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5780
Practice Address - Country:US
Practice Address - Phone:330-825-7371
Practice Address - Fax:330-634-1329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIONEER PHYSICIANS NETWORK, INCL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-01
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty