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Organization

PINE MOUNTAIN CLINIC PSC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MADHAN MOHAN MD (OWNER)
(606) 337-6047
Entity
Organization

Contact information

Practice address
850 RIVERVIEW RD, PINEVILLE, KY 40977-1430
(606) 337-6047
(606) 337-0925
Mailing address
850 RIVERVIEW RD, PO BOX 308, PINEVILLE, KY 40977-1430
(606) 337-6047
(606) 337-0925

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29667
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
65930851
KY
Enumeration date
04/23/2007
Last updated
01/07/2026
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