Provider Demographics
NPI:1558301622
Name:PIMENTEL, FRANCIS J (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:J
Last Name:PIMENTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MEDICAL LN
Mailing Address - Street 2:PO BOX 250
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653-4216
Mailing Address - Country:US
Mailing Address - Phone:606-376-7212
Mailing Address - Fax:606-376-7216
Practice Address - Street 1:71 MEDICAL LANE
Practice Address - Street 2:SOUTH FORK MEDICAL CLINIC
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-0071
Practice Address - Country:US
Practice Address - Phone:606-376-7212
Practice Address - Fax:606-376-7216
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY23566207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3332230Medicaid
KY64004542Medicaid
TNB02947Medicare UPIN
KY64004542Medicaid
0739611Medicare PIN
0739611Medicare PIN