Provider Demographics
NPI:1487747903
Name:PIONEER MEDICAL INC
Entity type:Organization
Organization Name:PIONEER MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-242-6655
Mailing Address - Street 1:566 MAINSTREAM DRIVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1237
Mailing Address - Country:US
Mailing Address - Phone:615-242-6655
Mailing Address - Fax:615-255-7416
Practice Address - Street 1:566 MAINSTREAM DRIVE
Practice Address - Street 2:SUITE 700
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1237
Practice Address - Country:US
Practice Address - Phone:615-242-6655
Practice Address - Fax:615-255-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000474332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39781OtherBLUE CROSS BLUE SHIELD TN
TN3543393OtherTENN CARE NUMBER
TN0149770001Medicare ID - Type UnspecifiedPROVIDER ID