Provider Demographics
NPI:1720277643
Name:PIKEVILLE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PIKEVILLE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAGY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-218-3500
Mailing Address - Street 1:911 BYPASS RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1689
Mailing Address - Country:US
Mailing Address - Phone:606-218-3500
Mailing Address - Fax:606-218-4560
Practice Address - Street 1:911 BYPASS RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2917
Practice Address - Country:US
Practice Address - Phone:606-218-3500
Practice Address - Fax:606-218-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100338252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45011319Medicaid