Basic Information
| Provider Information | |||||||||
| NPI: | 1801899679 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PIONEER HEALTH SERVICES OF NEWTON COUNTY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEWTON FAMILY AND SPECIALTY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9421 EASTSIDE DRIVE EXTENTION | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018491682 | ||||||||
| FaxNumber: | 6018491969 | ||||||||
| Practice Location | |||||||||
| Address1: | 9421 EASTSIDE DRIVE EXTENTION | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393452613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016832031 | ||||||||
| FaxNumber: | 6016830262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 09/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | MCNULTY | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6018491682 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 16-321 | MS | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.