Provider Demographics
NPI:1225270861
Name:PIKEVILLE MEDICAL OFFICES
Entity Type:Organization
Organization Name:PIKEVILLE MEDICAL OFFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:606-432-0168
Mailing Address - Street 1:180 TOWN MOUNTAIN RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1698
Mailing Address - Country:US
Mailing Address - Phone:606-432-0168
Mailing Address - Fax:606-432-0639
Practice Address - Street 1:180 TOWN MOUNTAIN RD
Practice Address - Street 2:SUITE 111
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1698
Practice Address - Country:US
Practice Address - Phone:606-432-0168
Practice Address - Fax:606-432-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty