# PINELAKE REGIONAL HOSPITAL LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Jackson Purchase Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891892741
- **Authorized official:** CHARLOTTE LAWRENCE (SECRETARY)
- **Authorized official phone:** (615) 920-7688

## Contact information

- **Practice address:** 1099 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1159
- **Practice address phone:** (270) 251-4100
- **Practice address fax:** (270) 251-4507
- **Mailing address:** 330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
- **Mailing address phone:** (615) 920-7000
- **Mailing address fax:** (615) 920-8913

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 100143 | KY | — |
| 282NR1301X | Rural Acute Care Hospital | 100143 | KY | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 01/15/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000055031 | BCBS | KY |
| 01 | — | 000000061925 | BCBS REFERENCE LAB | KY |
| 05 | — | 01000116 | — | KY |
| 01 | — | 030016699 | USEC DEPT. OF LABOR | KY |
| 01 | — | 360503 | BLACK LUNG | KY |