Provider Demographics
NPI:1164558417
Name:PIKEVILLE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:PIKEVILLE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAGY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-218-3974
Mailing Address - Street 1:911 BYPASS RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1689
Mailing Address - Country:US
Mailing Address - Phone:606-218-3576
Mailing Address - Fax:606-218-3961
Practice Address - Street 1:911 BYPASS RD BLDG E
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-218-3576
Practice Address - Fax:606-218-3961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP065193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54030903Medicaid