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General NPI Number Information
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NPI Number | 1225270861
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Entity Type | Organization
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Legal Business Name | PIKEVILLE MEDICAL OFFICES
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 180 TOWN MOUNTAIN RD SUITE 111
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City | PIKEVILLE
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State | KY
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Zip | 41501-1698
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Country | US
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Telephone | 606-432-0168
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Fax | 606-432-0639
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Provider Business Mailing Address
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Address Line | 180 TOWN MOUNTAIN RD SUITE 111
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City | PIKEVILLE
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State | KY
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Zip | 41501-1698
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Country | US
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Telephone | 606-432-0168
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Fax | 606-432-0639
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Authorized Official
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Title or Position | MANAGER
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Name | ALLEN R MAYNARD
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Credential | PA-C
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Telephone | 606-432-0168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State | KY
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