Healthcare Provider Details

I. General information

NPI: 1194967109
Provider Name (Legal Business Name): PIKEVILLE MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 S MAYO TRL
PIKEVILLE KY
41501-1309
US

IV. Provider business mailing address

PO BOX 2917
PIKEVILLE KY
41502-2917
US

V. Phone/Fax

Practice location:
  • Phone: 606-430-4750
  • Fax: 606-328-5348
Mailing address:
  • Phone: 606-430-3519
  • Fax: 606-432-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number100366
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number100366
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number100366
License Number StateKY

VIII. Authorized Official

Name: MICHELLE HAGY
Title or Position: CFO
Credential:
Phone: 606-430-3519