Organization
PINELAKE PHYSICIAN PRACTICE LLC
Active
Other names
Jackson Purchase ENT & Aesthetic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY D VAUGHN (VICE PRESIDENT)
(615) 372-8500
Entity
Organization
Contact information
Practice address
1111 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1194
(270) 251-4080
(270) 251-4081
Mailing address
1029 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1189
(270) 251-4080
(270) 251-4081
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
05/27/2010
Last updated
05/27/2010
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