Provider Demographics
NPI:1457488744
Name:PIKEVILLE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:PIKEVILLE MEDICAL CENTER, INC.
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:606-218-3500
Mailing Address - Fax:606-218-4562
Practice Address - Street 1:911 BYPASS RD
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:606-218-3500
Practice Address - Fax:606-218-4562
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:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X
KY730093261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100032480Medicaid
KY65928129Medicaid
KY000000056961OtherBCBS PHYSICIAN GROUP
KY0136Medicare PIN
KY7100032480Medicaid