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General NPI Number Information
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NPI Number | 1700970613
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Entity Type | Organization
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Legal Business Name | PINEVILLE PRIMARY CARE, PSC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 850 RIVERVIEW RD THIRD FLOOR
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City | PINEVILLE
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State | KY
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Zip | 40977-1430
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Country | US
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Telephone | 606-337-7157
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Fax |
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Provider Business Mailing Address
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Address Line | 332 CYPRESS ST
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City | PINEVILLE
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State | KY
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Zip | 40977-1422
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Country | US
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Telephone | 606-337-7157
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEVAPIRAN JAISHANKAR
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Credential | M.D.
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Telephone | 606-337-7157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 32079
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 33451
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License Number State | TN
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