Basic Information
| Provider Information | |||||||||
| NPI: | 1144535212 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PIONEER HEALTH SERVICES OF EARLY COUNTY, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | SWING BED | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11740 COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | BLAKELY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 398232574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018491682 | ||||||||
| FaxNumber: | 6018491969 | ||||||||
| Practice Location | |||||||||
| Address1: | 11740 COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | BLAKELY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 398232574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018491682 | ||||||||
| FaxNumber: | 6018491969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2010 | ||||||||
| LastUpdateDate: | 08/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | MCNULTY | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6018491682 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | N | Hospital Units | Medicare Defined Swing Bed Unit | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.