Provider Demographics
NPI:1194058446
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 1:4880 S MAIN ST
Mailing Address - Street 2:STE 4
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-4474
Mailing Address - Country:US
Mailing Address - Phone:330-923-2700
Mailing Address - Fax:330-634-1329
Practice Address - Street 1:1640 CORPORATE WOODS CIR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7819
Practice Address - Country:US
Practice Address - Phone:330-899-9350
Practice Address - Fax:330-899-9395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIONEER PHYSICIANS NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-17
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty