Basic Information
| Provider Information | |||||||||
| NPI: | 1841426996 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIKEVILLE MEDICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 432 | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415020432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064303500 | ||||||||
| FaxNumber: | 6064325422 | ||||||||
| Practice Location | |||||||||
| Address1: | 1520 SLATE CREEK RD | ||||||||
| Address2: | |||||||||
| City: | GRUNDY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246146975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2769351640 | ||||||||
| FaxNumber: | 2769350688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2009 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | HAGY | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6062183500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PIKEVILLE MEDICAL CENTER, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.