Provider Demographics
NPI: | 1528195864 |
---|---|
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: | MRS |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HAGY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 606-430-3519 |
Mailing Address - Street 1: | PO BOX 432 |
Mailing Address - Street 2: | |
Mailing Address - City: | PIKEVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 41502-0432 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 606-430-3500 |
Mailing Address - Fax: | 606-432-5422 |
Practice Address - Street 1: | 911 BYPASS RD BLDG A |
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: | 606-430-3500 |
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: | 2024-03-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 1223S0112X | Dental Providers | Dentist | Oral and Maxillofacial Surgery | Group - Multi-Specialty |
No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
No | 2080B0002X | Allopathic & Osteopathic Physicians | Pediatrics | Obesity Medicine | Group - Multi-Specialty |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
No | 261QS1200X | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic | Group - Multi-Specialty |
No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100025550 | Medicaid | |
KY | 000000056963 | Other | BCBS ANESTHESIA GROUP |
KY | 7100032480 | Medicaid | |
KY | 000000056961 | Other | BCBS PHYSICIAN GROUP |
KY | 3100076300 | Medicaid | |
KY | 7100075930 | Medicaid | |
KY | 7100294240 | Medicaid | |
KY | 7100332320 | Medicaid | |
KY | 65922361 | Medicaid | |
KY | 7100025560 | Medicaid | |
KY | 7100025560 | Medicaid | |
KY | 0136 | Medicare PIN |