| Pioneer Wellness Network | |
|
629 Pioneer St Kalamazoo MI 49008-1860 | |
| (269) 381-2437 | |
| (269) 381-4050 |
| Full Name | Pioneer Wellness Network |
|---|---|
| Speciality | Social Worker |
| Location | 629 Pioneer St, Kalamazoo, Michigan |
| Authorized Official Name and Position | Kelly A Doyle (CEO) |
| Authorized Official Contact | 2693812437 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pioneer Wellness Network 629 Pioneer St Kalamazoo MI 49008-1860 Ph: (269) 381-2437 | Pioneer Wellness Network 629 Pioneer St Kalamazoo MI 49008-1860 Ph: (269) 381-2437 |
| NPI Number | 1851590855 |
|---|---|
| Provider Enumeration Date | 07/11/2007 |
| Last Update Date | 03/24/2023 |
| Certification Date | 03/24/2023 |
| Medicare PECOS PAC ID | 2668565102 |
|---|---|
| Medicare Enrollment ID | O20071023000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851590855 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| Provider Name | Mary Kathleen Jackson-spaner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487145587 PECOS PAC ID: 0446638852 Enrollment ID: I20220525001789 |
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