Provider Demographics
NPI:1518206010
Name:PINEVILLE COMMUNITY HOSPITAL ASSN INC
Entity type:Organization
Organization Name:PINEVILLE COMMUNITY HOSPITAL ASSN INC
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:606-337-4282
Mailing Address - Street 1:850 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1452
Mailing Address - Country:US
Mailing Address - Phone:606-337-4282
Mailing Address - Fax:606-337-2871
Practice Address - Street 1:850 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1452
Practice Address - Country:US
Practice Address - Phone:606-337-4282
Practice Address - Fax:606-337-2871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINEVILLE COMMUNITY HOSPITAL ASSN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-05
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100020273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01011352Medicaid
KY01011352Medicaid