Healthcare Provider Details

I. General information

NPI: 1023011921
Provider Name (Legal Business Name): PIKEVILLE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 S MAYO TRL
PIKEVILLE KY
41501-2332
US

IV. Provider business mailing address

PO BOX 2917
PIKEVILLE KY
41502-2917
US

V. Phone/Fax

Practice location:
  • Phone: 606-218-4570
  • Fax: 606-218-4587
Mailing address:
  • Phone: 606-218-4570
  • Fax: 606-218-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150185
License Number StateKY

VIII. Authorized Official

Name: MICHELLE HAGY
Title or Position: CFO
Credential:
Phone: 606-218-3500