Provider Demographics
NPI:1578194890
Name:PINEVILLE ER SERVICES
Entity Type:Organization
Organization Name:PINEVILLE ER SERVICES
Other - Org Name:ADVANCED RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VELUPILLAI
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGNAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-619-1372
Mailing Address - Street 1:1625 NICHOLASVILLE RD APT 201
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1446
Mailing Address - Country:US
Mailing Address - Phone:859-619-1372
Mailing Address - Fax:
Practice Address - Street 1:218 E PARK AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1720
Practice Address - Country:US
Practice Address - Phone:606-302-5464
Practice Address - Fax:606-545-0135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINEVILLE ER SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-27
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care