Healthcare Provider Details

I. General information

NPI: 1104864107
Provider Name (Legal Business Name): PHILIP LEFEUVRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 RIVERVIEW AVE.
PINEVILLE KY
40977-1430
US

IV. Provider business mailing address

850 RIVERVIEW AVE.
PINEVILLE KY
40977
US

V. Phone/Fax

Practice location:
  • Phone: 606-337-5900
  • Fax: 606-337-6080
Mailing address:
  • Phone: 606-337-5900
  • Fax: 606-337-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number32827
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number32827
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: