Provider Demographics
NPI:1366491177
Name:PIKEVILLE MEDICAL EQUIPMENT & SUPPLIES, INC.
Entity Type:Organization
Organization Name:PIKEVILLE MEDICAL EQUIPMENT & SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:GOODMAN
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-432-6011
Mailing Address - Street 1:PO BOX 3816
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-3816
Mailing Address - Country:US
Mailing Address - Phone:606-432-6011
Mailing Address - Fax:606-432-6085
Practice Address - Street 1:789A N MAYO TR
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1686
Practice Address - Country:US
Practice Address - Phone:606-432-6011
Practice Address - Fax:606-432-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYNOT REQUIRED IN KY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000320773OtherANTHEM
KY90007188Medicaid
KY90007188Medicaid