Provider Demographics
NPI:1093205593
Name:PINEVILLE MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PINEVILLE MEDICAL CENTER, LLC
Other - Org Name:SOUTHEASTERN KY TOTAL CARE RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-337-3051
Mailing Address - Street 1:850 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1452
Mailing Address - Country:US
Mailing Address - Phone:606-337-3051
Mailing Address - Fax:606-337-2871
Practice Address - Street 1:121 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1661
Practice Address - Country:US
Practice Address - Phone:606-337-3051
Practice Address - Fax:606-337-2871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINEVILLE MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health