| Pioneer Medical Pa Llc | |
|
132 Block Rd Portage PA 15946-6905 | |
| (901) 603-6113 | |
| Not Available |
| Full Name | Pioneer Medical Pa Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 132 Block Rd, Portage, Pennsylvania |
| Authorized Official Name and Position | Jeffery Copeland (OWNER) |
| Authorized Official Contact | 9016036113 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pioneer Medical Pa Llc 132 Block Rd Portage PA 15946-6905 Ph: () - | Pioneer Medical Pa Llc 132 Block Rd Portage PA 15946-6905 Ph: (901) 603-6113 |
| NPI Number | 1376296525 |
|---|---|
| Provider Enumeration Date | 01/28/2022 |
| Last Update Date | 08/22/2022 |
| Medicare PECOS PAC ID | 9234517632 |
|---|---|
| Medicare Enrollment ID | O20220525001533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376296525 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Daniel B Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811448426 PECOS PAC ID: 6406132430 Enrollment ID: I20170406000041 |
| Provider Name | Sarah Lynn Gallardy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831761873 PECOS PAC ID: 3779988928 Enrollment ID: I20210825004039 |
| Provider Name | Jeffery Copeland |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245618768 PECOS PAC ID: 2769793249 Enrollment ID: I20220525001491 |
| Provider Name | Destiny Marie Staines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588395057 PECOS PAC ID: 8527442334 Enrollment ID: I20220829000658 |
Conemaugh Physician Group - Portage Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3670 Portage St, Ste 105, Portage, PA 15946 Phone: 814-736-9614 Fax: 814-736-9783 | |
Conemaugh Health Initiatives Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3670 Portage St, Portage, PA 15946 Phone: 814-736-9614 Fax: 814-736-9783 |