Provider Demographics
NPI:1033291695
Name:THE FAMILY PRACTICE OF DR. GEORGE M. PITTMAN PLLC
Entity Type:Organization
Organization Name:THE FAMILY PRACTICE OF DR. GEORGE M. PITTMAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-369-0070
Mailing Address - Street 1:PO BOX 3486
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-7486
Mailing Address - Country:US
Mailing Address - Phone:804-402-5403
Mailing Address - Fax:800-518-9245
Practice Address - Street 1:3190 IRVINE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-9031
Practice Address - Country:US
Practice Address - Phone:859-369-0070
Practice Address - Fax:859-369-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000351815OtherANTHEM
KY1518OtherBC
KYP00222112OtherRRMC
KY18D0946970OtherCLIA
KY0100012OtherUHC
KYBP4131568OtherDEA
KY0100012OtherUHC
KYP00222112OtherRRMC
KY9670Medicare PIN