Provider Demographics
NPI:1174556955
Name:PIONEER MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:PIONEER MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PIONEER MEDICAL ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANDEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-373-4296
Mailing Address - Street 1:765 LIBERTY ST
Mailing Address - Street 2:SUITE # 307
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2566
Mailing Address - Country:US
Mailing Address - Phone:814-336-1140
Mailing Address - Fax:814-724-2196
Practice Address - Street 1:765 LIBERTY ST
Practice Address - Street 2:SUITE # 307
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2566
Practice Address - Country:US
Practice Address - Phone:814-336-1140
Practice Address - Fax:814-724-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059886L207Q00000X
PAOS012266207Q00000X
PAMD052734L207R00000X
PAMD017026E207R00000X
PAMD072890L207R00000X
PAMD012950E207R00000X
PAOS012833207R00000X
PAOT011268207R00000X
PAMD434741207R00000X
PAOS014457207Q00000X
PAOS008804L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA033614Medicare ID - Type UnspecifiedGROUP NUMBER