Provider Demographics
NPI:1639472137
Name:PIKEVILLE CLINIC, LLC
Entity Type:Organization
Organization Name:PIKEVILLE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOYNTON
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:423-447-2955
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37367-0349
Mailing Address - Country:US
Mailing Address - Phone:423-447-2955
Mailing Address - Fax:423-447-2405
Practice Address - Street 1:3062 MAIN ST
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37367-5746
Practice Address - Country:US
Practice Address - Phone:423-447-2955
Practice Address - Fax:423-447-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty