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Organization
PINELAKE PHYSICIAN PRACTICE LLC
Active
Organization
PINELAKE PHYSICIAN PRACTICE LLC
Active
Other names
Jackson Purchase Family and Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENIS MILLER (REGIONAL DIRECTOR)
(615) 934-1454
Entity
Organization
Contact information
Practice address
1111 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1194
(270) 251-4085
(270) 251-4086
Mailing address
1029 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1189
(270) 251-4547
(270) 251-4546
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
NULL
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
09/30/2010
Last updated
09/30/2010
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