1194967109 NPI number — PIKEVILLE MEDICAL CENTER INC.

Table of content: (NPI 1194967109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194967109 NPI number — PIKEVILLE MEDICAL CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIKEVILLE MEDICAL CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PIKEVILLE MEDICAL CENTER HOME MEDICAL EQUIPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194967109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2917
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKEVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41502-2917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-430-3519
Provider Business Mailing Address Fax Number:
606-432-9479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 S MAYO TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-430-4750
Provider Business Practice Location Address Fax Number:
606-328-5348
Provider Enumeration Date:
04/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HAGY
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
606-430-3519

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  100366 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , with the licence number: 100366 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 100366 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0311980002 . This is a "PTAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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