NPIMap

Organization Active NPI

Pioneer Health Services of Early County LLC

  • Community/Retail Pharmacy
  • Blakely, GA
National Provider Identifier
1043301872
Registry record updated Jul 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE09691 Issued in GA
Legal business name
PIONEER HEALTH SERVICES OF EARLY COUNTY LLC
Practice address
11740 Columbia St
Blakely, GA 39823-2574
Phone
(229) 724-4208
Fax
(229) 724-4268
NPI assigned
Sep 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wade Cook
Title
Dir of Phcy
Phone
(229) 724-4208

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHRE09691 GA Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

11740 Columbia St
Blakely, GA 39823-2574

Mailing address

11740 Columbia St
Blakely, GA 39823-2574
Phone (229) 724-4208

Other identifiers 2

IdentifierTypeStateIssuer
2127003OtherPK
000000635AMedicaidGA

Other names 1

  • Pioneer Community Hospital of Early Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Early Memorial Hospital6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435795200000",
    "number": "1043301872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11740 COLUMBIA ST",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398232574",
            "telephone_number": "229-724-4208",
            "fax_number": "229-724-4268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11740 COLUMBIA ST",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398232574",
            "telephone_number": "229-724-4208",
            "fax_number": "229-724-4268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER HEALTH SERVICES OF EARLY COUNTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2015-07-02",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "WADE",
        "authorized_official_title_or_position": "DIR OF PHCY",
        "authorized_official_telephone_number": "229-724-4208"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE09691",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2127003",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000635A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pioneer Community Hospital of Early",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blakely, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.