Organization
SOUTHFORK MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANCIS PIMENTEL MD (MEDICAL DIRECTOR)
(606) 376-7212
Entity
Organization
Contact information
Practice address
71 MEDICAL LN, WHITLEY CITY, KY 42653-4216
(606) 376-7212
(606) 376-7216
Mailing address
71 MEDICAL LN, WHITLEY CITY, KY 42653-4216
(606) 376-7212
(606) 376-7216
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07396
MEDICARE B
KY
05
—
35001593
—
KY
Enumeration date
11/29/2005
Last updated
08/23/2011
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