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General NPI Number Information
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NPI Number | 1386156610
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Entity Type | Organization
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Legal Business Name | LOG MOUNTAIN FAMILY HEALTHCARE LLC
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 101 MOUNTAIN VIEW CMNS
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City | PINEVILLE
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State | KY
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Zip | 40977-8708
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Country | US
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Telephone | 606-337-8887
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13
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City | PINEVILLE
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State | KY
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Zip | 40977-0013
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Country | US
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Telephone | 606-337-8887
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIFFENY JEAN TREECE
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Credential |
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Telephone | 606-337-8887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | KY
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