Provider Demographics
NPI:1346620176
Name:PIKEVILLE SPINE, SPORTS & JOINT PAIN CENTER L.L.C,.
Entity Type:Organization
Organization Name:PIKEVILLE SPINE, SPORTS & JOINT PAIN CENTER L.L.C,.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTTY
Authorized Official - Middle Name:R
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-432-2852
Mailing Address - Street 1:PO BOX 2144
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-2144
Mailing Address - Country:US
Mailing Address - Phone:606-432-2852
Mailing Address - Fax:606-432-2856
Practice Address - Street 1:419 TOWN MOUNTAIN RD STE 103
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1632
Practice Address - Country:US
Practice Address - Phone:606-432-2852
Practice Address - Fax:606-432-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-06
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34819208100000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64058761Medicaid
KY0980303Medicare PIN
H67816Medicare UPIN
KY1251001Medicare PIN
KY3403780Medicare PIN