Healthcare Provider Details

I. General information

NPI: 1457488744
Provider Name (Legal Business Name): PIKEVILLE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BYPASS RD
PIKEVILLE KY
41501-1689
US

IV. Provider business mailing address

PO BOX 2917
PIKEVILLE KY
41502-2917
US

V. Phone/Fax

Practice location:
  • Phone: 606-218-3500
  • Fax: 606-218-4562
Mailing address:
  • Phone: 606-218-3500
  • Fax: 606-218-4562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number730093
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

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