Provider Demographics
NPI:1437286770
Name:PIKEVILLE MEDICAL CENTER, INC. (PIKEVILLE FAMILY PRACTICE CLINIC)
Entity Type:Organization
Organization Name:PIKEVILLE MEDICAL CENTER, INC. (PIKEVILLE FAMILY PRACTICE CLINIC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-218-3500
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2917
Mailing Address - Country:US
Mailing Address - Phone:606-218-4800
Mailing Address - Fax:
Practice Address - Street 1:184 S MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1518
Practice Address - Country:US
Practice Address - Phone:606-218-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIKEVILLE MEDICAL CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700101261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000763Medicaid
KY000000056961OtherBCBS PHYSICIAN GROUP
KY000000056961OtherBCBS PHYSICIAN GROUP
KYC16210Medicare PIN