Provider Demographics
NPI:1891833067
Name:SAMUEL P PIKE MD
Entity Type:Organization
Organization Name:SAMUEL P PIKE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-765-6242
Mailing Address - Street 1:100 HELMWOOD PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2975
Mailing Address - Country:US
Mailing Address - Phone:270-765-6242
Mailing Address - Fax:270-765-6243
Practice Address - Street 1:100 HELMWOOD PLAZA DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2975
Practice Address - Country:US
Practice Address - Phone:270-765-6242
Practice Address - Fax:270-765-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063462935OtherERIN BRYANT ARNP NPI
KY000000047212OtherANTHEM
1104832310OtherNPI
KY9851Medicare PIN
C74120Medicare UPIN