Provider Demographics
NPI:1922150911
Name:PINEVILLE COMMUNITY HOSPITAL REFERENCE LAB
Entity Type:Organization
Organization Name:PINEVILLE COMMUNITY HOSPITAL REFERENCE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-337-3051
Mailing Address - Street 1:850 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1430
Mailing Address - Country:US
Mailing Address - Phone:606-337-3051
Mailing Address - Fax:606-337-2871
Practice Address - Street 1:850 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1430
Practice Address - Country:US
Practice Address - Phone:606-337-3051
Practice Address - Fax:606-337-2871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18D0323967291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000061950OtherANTHEM BCBS REFERENCE LAB