Organization
PINELAKE PHYSICIAN PRACTICE LLC
Active
Organization
PINELAKE PHYSICIAN PRACTICE LLC
Active
Other names
Jackson Purchase Primary Care Hussain Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY TEAGUE (SECRETARY)
(615) 920-7000
Entity
Organization
Contact information
Practice address
417 S 6TH ST, MAYFIELD, KY 42066-2311
(270) 247-1104
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7000
(915) 920-8775
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
11/15/2019
Last updated
11/15/2019
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