Organization Name: | PIONEER MEDICAL, LLC |
NPI Number: | 1356586762 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRAD H MASSEY (OWNER) |
Mailing Address: | 100 Clarendon Ave Petal |
State: | MS US |
Postal Code: | 394652636 |
Phone Number: | 8669519727 |
Fax Number: | |
NPI Enumeration Date: | 12/14/2008 |
NPI Last Update Date: | 12/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0208X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Radiology, Mobile |
Taxonomy Definition: |